President of the PHAC before the Standing Committee on Health: Supplementary Estimates (B), 2019-20

Table of Contents

• Opening Remarks
• Financial Notes
• Main Estimates
• QP Note
• Plates
• Supplementary Estimates B
• QP Note
• Plates
• Funding for a community-based approach to dementia
• Funding for addressing the challenges faced by black Canadians
• Funding for actions to protect Canadians and prevent overdose deaths
• Funding to support the Métis Nation in gathering health data and developing a strategy
• Reinvestment of royalties from intellectual property
• Transfer from the National Research Council of Canada to the Public Health Agency of Canada for genomics research and development
• Transer from the department of National Defence to Public Health Agency for the Canadian safety and security program
• Transfer from Health Canada to the Public Health Agency of Canada to support activities related to economic costing of climate change and health
• Transfer from the PSPC to various organizations, to implement and support cluster management offices as part of the Federal Sciences and Technology Infrastructure Initiative
• Transfer from the Health Canada to Public Health Agency of Canada for the OECD work on chemicals management and pesticides
• Transfer from the Health Canada to Public Health Agency of Canada to develop international scientific advice on food allergens
• Transfer from the Health Canada to Public Health Agency of Canada for the UN Office of Drugs and Crime
• Transfer from Health Canada to Public Health Agency of Canada to expand health information in the Climate Atlas of Canada
• Transfer to the RCMP from the Public Health Agency of Canada for the performance of law enforcement records
• Transfer from Public Health Agency of Canada to CIHR to participate in the EU Joint Programme – Neurodegenerative Disease Research
• Additional Information
• QP Notes
• Antimicrobial Resistance
• Autism
• Concussion
• COVID-19
• Dementia
• Diabetes
• GBV
• HIV / STBBIs
• LGBTQ2
• Lyme disease
• Measles
• Physical Activity
• PTSD Framework
• Seasonal Flu
• Seniors Health
• Suicide Prevention
• Tuberculosis
• Vaccination
• HC LED QP Notes
• Cannabis
• Climate Change (PHAC provided input)
• Opioids
• Vaping – Lung related Injury (PHAC provided input)
• Mental Health
• Sexual and Reproductive Health
• Dental Care (PHAC provided input)

Opening Remarks

Health Portfolio Supplementary Estimates (B)

March 11, 2020
Ottawa, ON

Introduction

Mr. Chair, I would like to thank you for inviting me before the Committee today. It is an honour to make my first appearance as Minister of Health.

I am grateful for this opportunity to talk about my mandate, our work in the Health Portfolio and our Financial Overview for Supplementary Estimates “B” for 2019-20.

I am accompanied today by:

• Dr. Stephen Lucas, Deputy Minister of Health Canada;
• Ms. Tina Namiesniowski, President of the Public Health Agency of Canada;
• Dr. Theresa Tam, Chief Public Health Officer, also with the Public Health Agency of Canada
• Catherine MacLeod, Executive Vice-President of the Canadian Institutes of Health Research; and
• Dr. Siddika Mithani, President of the Canadian Food Inspection Agency.

I may turn to them occasionally to provide more detail on our resourcing plans. But first, I would like to talk about our ongoing response to the COVID-19 outbreak. As you know, this situation is evolving quickly.

The number of cases in Canada and around the world continues to increase. Globally, there are now more than 100 countries affected.

While our focus continues to be on containing the virus to delay the onset of community transmission, we are preparing for the possibility of a more widespread outbreak.

It is at times like these that we see how important it is to have a strong, coordinated approach to public health. Public servants at all levels of government have been working extremely long hours to protect Canadians. I want to recognize them for their dedication and professionalism in the face of this international health threat.

The Public Health Agency of Canada, for example, is working closely with the provinces and territories to ensure a consistent, evidence-based approach to addressing this crisis. 

At the federal level, we are conducting national disease surveillance and providing guidance on public health measures. I have weekly conversations with my provincial and territorial counterparts.

Our National Microbiology Laboratory is helping to confirm new cases of COVID-19 and conducting research to advance our understanding of the virus.

Last week, I had the pleasure of announcing that the Canadian Institutes of Health Research is investing nearly $27 million over two years in coronavirus research. This investment will support research on diagnostic tools and candidate vaccines, as well as strategies to tackle misinformation, stigma and fear.

Ensuring access to vaccines and antivirals is a top priority. While there are currently no drugs specifically authorized to treat COVID-19, there are a variety of authorized treatment options including general antiviral drugs that are being used to treat patients infected with COVID-19.

Health Canada encourages companies and researchers with drugs that could be effective in the treatment of COVID-19 to contact the Department. Clinical trials can be authorized and established very quickly, particularly in urgent circumstances.

Health Canada is also leading federal workplace health initiatives, ensuring regulatory preparedness, and providing occupational health and safety advice and guidelines for federal employees.

As Minister of Health, I am focused on how this virus is affecting the health of Canadians and our health care system. But there is more to it than that. COVID-19 has already had a negative effect on the global economy. We must prepare for the possibility of a wide range of impacts.

Last week, the Prime Minister announced a new Cabinet Committee to oversee the federal response to COVID-19.

This committee, chaired by Deputy Prime Minister Freeland, will allow us to ensure government-wide planning and proactive response to protect the health and safety of Canadians, respond to impacts on workers and businesses, and ensure that the government can continue to deliver its services to Canadians across a range of scenarios.

COVID-19 is a serious public health challenge, but we are ready. The government is working on all fronts to protect the health, safety and well-being of Canadians. We will continue working closely with the provinces and territories, Indigenous peoples, businesses and communities to minimize the health, economic and social impacts of this rapidly evolving public health issue. I will keep this Committee informed of new developments as they arise.

My mandate

Our response to COVID-19 illustrates the Government’s — and my — commitment to protecting the health and well-being of Canadians.

While my mandate as Minister of Health is far-reaching and touches many important issues, I will highlight just a few for you today.

Strengthening public health care

As Minister, I am leading the Government’s work to strengthen public health care for all Canadians. We are working toward a national universal pharmacare program so that Canadians can access the prescription drugs they need without worrying about the cost. We have already strengthened our regulatory approach to pharmaceutical pricing. This will help lower the prices Canadians pay for patented medicines and make pharmacare more affordable. Budget 2019 provided support for Canadians who need access to high cost drugs for rare diseases, as well as funding to create a Canadian Drug Agency, which will lower drug costs further.

While access to medication is an essential element of health, Canadians must also have access to a doctor when they need one. This is especially important when faced with an emerging crisis, as we are now. Our goal is to ensure that each and every Canadian has timely access to a family doctor or primary health care team.

And because there can be no true physical health without mental health, we are working to set national standards for access to mental health services. It is so important that Canadians have access to mental health supports when they need them.

Canadians should also have improved access to home care and palliative care. I am pleased to say that we have made progress, through the Framework on Palliative Care in Canada and our supporting Action Plan, which aim to make home care and palliative care more accessible across the country.

For some, having access to Medical Assistance in Dying — or MAID — is an important aspect of end-of-life care. As you know, a few weeks ago, the Minister of Justice introduced amendments to the existing MAID legislation.
The proposed amendments are designed to make MAID more accessible to those who qualify for it, while ensuring that vulnerable individuals are protected.

Problematic Substance Use

As Minister of Health, I am also focused on addressing problematic substance use. As you know, Canada remains in the grip of a deadly opioid overdose crisis — one that has claimed the lives of nearly 14,000 Canadians since 2016. Our Government understands that this crisis requires a comprehensive, compassionate and evidence-based response.

We must protect Canadians from lethally potent, illegally produced synthetic drugs, like fentanyl. These drugs are now found in communities across the country and are the main cause of overdoses. We must also tackle the root causes of substance use and addiction, such as mental illness, trauma and pain. This includes stigma, which unfairly marginalizes people and prevents them from getting help.

Through our public education and awareness efforts, we are working to end the discrimination experienced by people who use drugs, to make it easier for them to get the care they need and deserve.

Managing risks to health

Managing the health risks that Canadians face doesn’t stop with opioids.

We continue to be concerned by the number of young Canadians who vape and we have taken action to restrict the promotion of vaping products where it can be seen or heard by youth.

We continue to play an active role in mitigating the impact of drug shortages on Canadians, working closely with provinces and territories, manufacturers, and others in the supply chain so that Canadians have access to the drugs they need. And, we are taking action, both domestically and abroad, to address the growing public health threat of antimicrobial resistance. This year we will release the Pan-Canadian Action Plan on Antimicrobial Resistance, which is being developed in collaboration with provincial, territorial and non-government partners.

Health Promotion

My mandate also includes health promotion. As part of that work, I am collaborating with the Minister of Canadian Heritage to implement a pan-Canadian Concussion Strategy and to raise awareness for parents, coaches and athletes on concussion treatment.

This includes the Concussion Harmonization Project, a comprehensive, evidence-based approach to addressing concussions wherever they occur.

Canadians living with Autism Spectrum Disorder have diverse and, often, complex needs. To address these needs effectively, everyone needs to be involved — from all levels of government, to service providers on the front lines. That’s why we are working collaboratively with provinces, territories, families and stakeholders toward the creation of a national autism strategy.

Research

Research is essential to the work we do in the Health Portfolio and is the foundation of our evidence-based approach.

Earlier, I mentioned our recent investment in COVID-19 research — this is just one example of our commitment to understanding the health challenges we face. For example, Budget 2019 provided $2.4 million over three years for research on plasma donation by men who have sex with men. This builds on ongoing efforts to reduce barriers to blood and plasma donation.

We are also working to ensure that sex, gender and diversity factors are included in research initiatives. This includes providing additional funding for grants to study race, diversity and gender.

Health Portfolio Supplementary Estimates (B)

I would now like to speak to the expenditure authorities of my Portfolio. If approved by Parliament, these Supplementary Estimates (B) will provide the Health Portfolio with an increase of $34.1 million in spending authorities. This represents an increase of 0.6%.

Health Canada

Let me begin with Health Canada, which has a budget of just under $2.7 billion.

This will increase only slightly with the Supplementary Estimates (B). We are not requesting any new funding at this time; however, some funds are being transferred to and from the Department to better support government health priorities.

Public Health Agency of Canada (PHAC)

Next, the Public Health Agencyof Canada is seeking voted authorities of $13 million and transfers of $1.8 million.

This new funding will go toward initiatives that address a number of key priorities, including: dementia, health challenges faced by Black Canadians, the drug overdose crisis and health data collection for the Métis Nation.

Canadian Food Inspection Agency (CFIA)

I will turn now to the Canadian Food Inspection Agency. In 2019-2020, this agency is expecting to receive an increase of $3.8 million.

This funding will be used, in part, to lead a cluster of science-based departments and agencies in renewing the Government of Canada’s science infrastructure.

Funding will also go toward the planning and design of the new Centre for Plant Health in Sidney, British Columbia. This centre will conduct research into diseases affecting fruit plants and trees.

Canadian Institutes of Health Research (CIHR)

Finally, I would like to talk about the Canadian Institutes of Health Research — or CIHR — which is proposing an increase of $15.1 million.

Of this, $2 million in new funding will go toward the B.C. Women’s Hospital and Health Centre, as part of the recently announced $10 million investment in research to eradicate cervical cancer in Canada.

In addition, $12.4 million is being transferred to the CIHR from the Natural Sciences and Engineering Research Council for the Canada Research Chairs Program. This is a tri-agency initiative to attract and retain a diverse community of researchers.

Conclusion

Everything we do within the Health Portfolio is aimed at protecting the health and well-being of Canadians — and we are committed to doing our job efficiently and effectively. This includes working with the provinces and territories to respond to COVID-19 and to strengthen the publicly funded health care system so that Canadians can have access to high-quality services.

I look forward to working with this Committee, and all of my colleagues in the House of Commons, to ensure that the health needs of all Canadians continue to be met.

Thank you for the opportunity to speak to you today. I am pleased to take questions from the Committee.

Financial Notes

Main Estimates

QP Note

Public Health Agency of Canada Main Estimates 2020-21

Synopsis

The Public Health Agency of Canada’s (PHAC) 2020-21 Main Estimates propose a net increase of $16.2 million over the 2019-20 Main Estimates of $625.6 million.

Key messages

• The Main Estimates capture departmental budgetary changes to the Public Health Agency of Canada since last year.
• Spending authorities increased by $16.2 million, to a total of

$641.8 million compared to the 2019-2020 Main Estimates of $625.6 million.

• This increase is mainly due to funding: for community-based projects that address the challenges of dementia and the implementation of a national dementia strategy; for collective bargaining agreements; to support actions to protect Canadians and prevent overdose death; to support development, implementation and evaluation of more culturally focused mental health programs in Black Canadian communities; and, to support the Métis Nation in gathering health data and developing a health strategy.
• This increase was offset by the sunset of funding to the Canadian Centre for Aging and Brain Health Innovation.

Background

The Main Estimates will capture departmental budgetary changes to the Public Health Agency of Canada since last year.

(In $ millions)	Vote 1	Vote 5	Vote 10	Sub-total	Statutory Items	Total
	Operating	Capital	Grants and contributions
Main estimates 2019-2020	336,4	7,8	238,4	582,6	43,1	625,6
New Treasury Board Submissions	10,3	0,0	9,1	19,4	1,5	21,0
Reprofiles	0,0	0,0	4,1	4,1	0,0	4,1
Transfer to/from other departments	0,6	0,0	0,9	1,5	(0,0)	1,5
Sunsetters and other technical adjustments	(6,0)	(1,0)	(1,7)	(8,7)	(1,6)	(10,3)
Total main estimates 2020-2021	341,3	6,8	250,8	598,9	42,9	641,8
Totals may not add due to rounding.

Public Health Agency of Canada’s 2020-21 Main Estimates are $641.8 million representing a net increase of $16.2 million over the 2019-20 Main Estimates of $625.6 million.

2020-21 Main Estimates major items

The net increase to reference levels for 2020-2021 is $16.2 million.
The increase is primarily attributable to new funding for:

• $9.3 million – National Dementia Strategy - “A Dementia Strategy for Canada: Inspiring a Healthy Journey”;
• $7.5 million – The collective bargaining agreements;
• $5.0 million – Community-based projects that address the challenges of dementia to help deliver and evaluate interventions to improve the wellbeing of people living with dementia;
• $4.9 million – Combating illegal drug use and protecting Canadians. This investment will be used to scale up key lifesaving measures, circumvent the toxic illegal drug supply, and identify and address emerging drug threats;
• $2.2 million – To support development, implementation and evaluation of more culturally focused mental health programs in Black Canadian communities;
• $1.2 million – Metis Nation regarding gathering health data and developing a health strategy; and

The above mentioned increases are offset by decreases attributable to:

• $10.0 million – Sunset in funding for the establishment of the Canadian Centre for Aging and Brain Health Innovation;

For information purposes, the 2020-21 Main Estimates include Statutory Appropriation of
$42.9 million consisting of:

• $29.5 million for Employee Benefit Plans; and
• $13.4 million in the statutory revenues is related to the internal services provided to the Public Health Agency of Canada by Health Canada.

Contact: Tomasz Popiel (Telephone: 613-946-5553)
Approved by: Carlo Beaudoin (Telephone: 613-948-5798)

Plates

2020–21 Main Estimates

Supplementary Estimates B

QP Note

Supplementary estimates (b) 2019-20

Synopsis

The Public Health Agency of Canada’s 2019–2020 Supplementary Estimates (B) requires approval by Parliament and captures the 2019-2020 departmental budgetary changes since Main Estimates, which have arisen mainly from approved Treasury Board submissions, reprofiles funding and transfers between departments and agencies.

Key messages

• For Supplementary Estimates (B), the Public Health Agency of Canada has a net increase of $15.1 million.
• This increase is mainly due to funding in the dementia community; to address the challenges faced by Black Canadians; for the drug overdose crisis in Canada; and, to support the Métis Nation in gathering health data.

Background

Supplementary Estimates seek Parliamentary approval of changes to departmental spending plans outlined in the Main Estimates during a fiscal year. Items included in the Supplementary Estimates have received approval from the sponsoring Ministers and Treasury Board.

Public Health Agency of Canada:

(In $ millions)	Vote 1	Vote 5	Vote 10	Sub-total	Statutory Items Footnote 2	Total
	Operating Footnote 1	Capital	Grants and contributions
Main Estimates Includes estimated Budget Implemation Vote	336,4	7,8	238,4	582,6	43,1	625,6
Operating and Capital Budget Carry Forward	13,9	1,4	0,0	15,3	0,0	15,3
Budget Implementation Vote - Adjusted	(5,1)	0,0	5,1	0,0	0,2	0,2
TB Contigency Vote	0,1	0,0	1,3	1,4	0,0	1,5
Paylist Reimbursement	1,9	0,0	1,9	0,0	0,0	1,9
Collective Bargaining Agreement	6,6	0,0	0,0	6,6	0,0	6,6
Total Estimated Authorities to date	353,8	9,2	244,9	607,8	43,3	651,1
Supplemetary Estimates (B)	8,6	(1,0)	7,2	14,9	0,3	15,1
Proposed Authorities to date	362,4	8,2	252,1	622,7	43,5	666,2
Totals may not add due to rounding. Table 1 Footnote 1 Represents salaries and other operating costs. Return to footnote 1 referrer Table 2 Footnote 2 Represents contributions to employee benefit plans, statutory spending authority as a result of the Shared Services Partnership agreement with the Health Canada. Return to footnote 2 referrer

PHAC’s 2019-2020 Supplementary Estimates (B) will capture the 2019-2020 departmental budgetary changes since Main Estimates, which have arisen from approved Treasury Board submissions and from transfers with partnering departments and agencies.

PHAC is requesting a net increase of $15.1 million from its reference levels based on :

A Voted increase of $13 million

• $3.9 million – Transfer from Salary to Operating to support a higher need for operating funding this fiscal year;
• $3.9 million – Funding for community-based projects that address the challenges of dementia to help deliver and evaluate interventions to improve the wellbeing of people living with dementia;
• $2.1 million – Funding to strengthen multiculturalism and address challenges faced by black Canadians. This investment will contribute to the increase sense of belonging and the promotion of diversity as a shared value amongst Canadians;
• $1.7 million – Funding to combat illegal drug use and protect Canadians. This investment will be used to scale up key lifesaving measures, circumvent the toxic illegal drug supply, and identify and address emerging drug threats;
• $1.2 million – Funding to support the Métis Nation in gathering health data and developing a strategy to better inform evidence-based policies, programs and services; and
• $218,000 - Reinvestment of royalties from licensing of Intellectual Property.

Internal Reallocation of Resources (net $0):

• $1 million – From Capital to Operating to support a higher need for operating funding this fiscal year.

Transfers in and out of PHAC: ($1.8 million)

• $845,000 – Transfer from the National Research Council of Canada for genomics research and development;

• $240,000 - Transfer from the Department of Defence for the Canadian Safety and Security Program;
• $180,000 - Transfer from the Department of Health for the World Health Organization economic evaluation of the impact of climate change on the health and health system;
• $178,000 – Transfer from the Department of Public Works and Government Services to implement and support cluster management offices as part of the Federal Sciences and Technology Infrastructure Initiative;
• $150,000 – Transfer from the Department of Health for the Organization for Economic Co-operation and Development work on chemical management and pesticides;
• $110,000 – Transfer from the Department of Health to develop international scientific advice on food allergens;
• $97,000 – Transfer from the Department of Health for the United Nations Office of Drugs and Crime;
• $75,000 – Transfer from the Department of Health to expand health information in the Climate Atlas of Canada;
• ($7,000) - Transfer to the Royal Canadian Mounted Police Canadian for law enforcement record checks; and
• ($58,000) - Transfer to the Canadian Institutes of Health Research to participate in the European Union Joint Programme – Neurodegenerative Disease Research.

Statutory Appropriations of $256,000:

Employee Benefit Plan adjustments related to increased Supplementary Estimates (B) salary funding for :

• $153,000 - Funding to combat illegal drug use and protect Canadians;
• $63,000 - Funding for community-based projects that address the challenges of dementia;
• $39,000 – Funding to strengthen multiculturalism and address challenges faced by black Canadians; and
• $1,000 - Reinvestment of royalties from licensing of Intellectual Property.

Contact: Tom Popiel (Telephone: 613-946-5553)
Approved by: Carlo Beaudoin (Telephone: 613-948-5798)

Plates

Supplementary Estimates (B), 2019–20

Funding for a community-based approach to dementia

Issue

Why is the Public Health Agency of Canada requesting $4 million to support community-based approaches to Dementia in the 2019–20 Supplementary Estimates (B)?

Reponse

• In June 2019, the Public Health Agency of Canada released Together We Aspire, Canada’s first national dementia strategy as required under the National Strategy for Alzheimer’s Disease and Other Dementias Act.
• The Dementia Community Investment, $20 million over 5 years and $4 million ongoing, funded through Budget 2018, will contribute to the implementation of key elements of the national dementia strategy.
• The Dementia Community Investment supports:
  • community-based projects that seek to optimize the wellbeing of people living with dementia and family/friend caregivers and increase knowledge of dementia and its risk factors by developing, testing and scaling up initiatives, knowledge and tools to support these communities; and
  • a Knowledge Hub that will facilitate a community of practice for the community-based projects funded by this investment, as well as translate and disseminate program findings and best practices to the dementia policy and program community across Canada.

Key facts

• Dementia is the loss of mental function affecting daily activities, caused by brain diseases and brain injuries. Alzheimer’s disease is the most common form of dementia.
• According to the most recent data available, more than 432,000 seniors (65 years and older) are living with diagnosed dementia in Canada. About two-thirds of Canadian seniors living with diagnosed dementia are women. Annually, there are approximately 78,600 new cases of dementia diagnosed in Canada.

Background

• In June 2017, the National Strategy for Alzheimer’s disease and Other Dementias Act came into force and called on the federal government to develop and implement a comprehensive national dementia strategy, hold a national conference to inform the development of the strategy, and establish a Ministerial Advisory Board on Dementia.
• Budget 2019 provided $50 million over five years for the Public Health Agency of Canada to further support key elements of the strategy’s implementation. This funding is expected to: increase awareness about dementia to support prevention, and reduce risk and stigma; develop treatment guidelines and best practices for early diagnosis; and improve our understanding of dementia and its impact through enhanced surveillance.
• People living with dementia and family/friend caregivers report negative impacts on their physical, emotional, mental and social wellbeing, including depression, anxiety, social isolation and physical inactivity.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Grants and Contributions	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	3	314	180.3	494.3	62.8	557.1	3,400	3,957.1
Total Funding	3	314	180.3	494.3	62.8	557.1	3,400	3,957.1

Allocation of Funds

• The Dementia Community Investment will invest in projects that propose:
  • innovative community-based solutions that address the inter-related objectives of: optimizing the wellbeing of people living with dementia and family/friend caregivers; increasing knowledge of dementia and its risk factors; and undertaking intervention research to assess the effectiveness of the program or initiative; and
  • projects targeting at risk populations (e.g., women, Indigenous populations) more susceptible to the potentially modifiable risk factors for dementia (e.g., physical inactivity, social isolation, depression) and/or experiencing barriers to accessing support (e.g., LGBTQ2+, Official Language Minority Communities).

Anticipated Results

The ultimate outcome from investments in projects through the Dementia Community Investment will be that Canadians living with dementia and family/friend caregivers have improved wellbeing as a result of improved access to and use of evidence based resources, knowledge and skills. Wellbeing refers to the diverse and interconnected dimensions of physical, emotional, mental and social states of being that extend beyond the traditional definition of health (i.e., the absence of disease).

Monitoring and Measurement

PHAC requires all funded projects to submit annual work plans, budgets and end of year performance reports that allow the Agency to track progress. Further, the Knowledge Hub will play an important role in translating and disseminating best practices for the dementia policy and program community across Canada.

Evaluation

The performance measurement and evaluation of the Dementia Community Investment will align with existing processes.

Date: February 21, 2020

Prepared by:

Janet Marth
Senior Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

List of DCI funded projects

Organizations	Main Focus	Amount of Funding and Duration	Publicly Announced Projects
Alzheimer Society of Canada	Summary: Toolkits and resources for a Dementia-Friendly Canada The ASC will collaborate and build on the work already done by the Alzheimer Societies of British Columbia, Manitoba, Ontario and Saskatchewan to create the vision of dementia-friendly communities across Canada, both in rural and urban areas. The ASC will develop a national Dementia-Friendly Canada (DFC) toolkit, which will include guides and tools to educate and train professionals in a variety of areas, such as transportation, recreation, libraries and the service sector. It will also include a module for the general public. A national dementia-friendly web page will also be created to showcase these new resources, as well as other relevant tools and related links.	$940,000 over 4 years	Publicly Announced
University of British Columbia	Summary: A community development approach to develop arts, fitness and other initiatives that improve the wellbeing of people living with dementia (PLWD) This project aims to develop and evaluate effective ways to create opportunities for people living with dementia, and family/friend caregivers, to remain active and connected in their communities. The project will develop dementia-inclusive toolkits to help facilitate the participation and inclusion of people living with dementia in decision-making on care, self-advocacy, leadership and community life, in a community in British Columbia and a community in Ontario. To improve the wellbeing of people living with dementia, the project will also develop initiatives in the areas of arts, social participation, fitness and volunteer activities.	$999,888 over 4 years	Publicly Announced
University of Alberta	Summary: A web-based social support intervention for family/friend caregivers of PLWD who have moved to long-term care This project is a web-based social support intervention for family/friend caregivers of people living with dementia who are residing in long-term care. It focuses on participants in Alberta, Saskatchewan, Manitoba, Ontario and Quebec, and aims to improve the health and mental wellbeing of family/friend caregivers by developing and testing a web-based intervention. This intervention has interactive activities and a variety of online resources such as tip sheets on communicating with people living with dementia, and guidance on communicating and working with staff in long-term care facilities.	$888,051 over 4 years	Publicly Announced
Native Women’s Association of Canada	Summary: An Indigenous peer support group and toolkit for caregivers of PLWD Through the development and testing of resources and community-based supports, this project aims to reduce social isolation and caregiver burnout, and increase family/friend caregiver knowledge of dementia, its risk factors and dementia caregiving strategies. The project will engage Elders to identify underserved communities in need of support, provide tools and resources for caregivers and establish support groups in four Indigenous communities to better support caregivers of people living with dementia.	$837,448 over 4 years	Publicly Announced
Inuvialuit Regional Corporation	Summary: Culturally sensitive in-home and community approaches/tools to address the needs of Inuit PLWD and family/friend caregivers Community engagement sessions will be held to help inform the creation of culturally sensitive educational resources, which will then be tested through in-community and in-home workshops in Inuit communities of the Inuvialuit Settlement Region of the Northwest Territories. The work of the IRC will provide these communities with culturally appropriate resources aimed at increasing the knowledge among family/friend caregivers. In addition, through a close partnership with the Government of Northwest Territories' Health and Social Services Authority, resources will be shared with long-term care staff to help ensure that Inuit Elders can receive more culturally appropriate care from non-Inuit professionals.	$939,500 over 4 years	Publicly Announced
Saint Elizabeth Health Care	Tools and processes to optimize the wellbeing of PLWD, address burnout/stress in caregivers and to build strong and effective relationships between PLWD, family/friend caregivers and care providers.	$158,455 over 2 years	N/A
Institute for Health System Transformation and Sustainability	Culturally sensitive and tailored interventions on advanced care planning and palliative care will be developed, implemented and tested in urban ethnocultural and LGBTQ2+ communities, and in four rural Saanich Village First Nations communities.	$699,969 over 2 years	N/A
Cummings Jewish Centre for Seniors	An intergenerational program that seeks to optimize the wellbeing for PLWD and family/friend caregivers through community engagement, activities, and educational supports.	$922,025 over 4 years	N/A
Société Alzheimer de Granby et région	Activities that can be reproduced at home will be taught to people living with dementia and caregivers; public awareness activities will also be conducted.	$940,112 over 4 years	N/A
Egale	Identify, develop and evaluate tools and resources to meet the needs of LGBTQI2S caregivers and PLWD and undertake an awareness campaign to share the products across Canada.	$814,563 over 4 years	N/A
The New Brunswick Association of Nursing Homes Incorporated	Develop a set of best practices, including toolkits and approaches for engaging lived experience to help other communities become more dementia-friendly.	$456,835 over 4 years	N/A
Hamilton Council on Aging	Develop and evaluate dementia-friendly action plans to reduce stigma, enhance wellbeing and social inclusion for PLWD and family/friend caregivers in both urban settings with age-friendly plans and rural settings without age-friendly plans.	$940,000 over 4 years	N/A

Funding for addressing the challenges faced by black Canadians

Issue

Why is the Public Health Agency of Canada requesting $2.1 million to address the challenges faced by Black Canadians in the 2019–20 Supplementary Estimates (B)?

Response

• This new funding for the Public Health Agency of Canada will support the development, implementation and evaluation of more culturally focused mental health programs in Black Canadian communities.
• Racism and discrimination persist as barriers preventing the full social and economic participation of affected communities and also negatively affect the mental health of racialized populations, and contribute to inequities in social and economic conditions that are linked to health.
• Budget 2018 allocated the Public Health Agency of Canada $10 million over 5 years to support the development, implementation, and evaluation of more culturally focused mental health programs in Black Canadian communities.

Key facts

• Funded projects will be led by or delivered in partnership with Black Canadian community-based organizations and leaders.
• Funded projects will acknowledge the unique social, economic, environmental and cultural factors that promote or hinder mental health among Black Canadians.
• Funded projects will produce new knowledge on effective, cultural focused mental health promotion interventions for Black Canadians.

Background

• Budget 2018 allocated $19 million over five years in new funding to enhance local community supports for youth at risk and to develop research in support of more culturally focused mental health programs in the Black Canadian community.
  • New funding of $10 million over five years was provided to the Public Health Agency
    (2018-19 $0.4 million; 2019-20 $2.1 million; 2020-21 $2.3 million; 2021-22 $2.6 million; and, 2022-23 $2.6 million).
  • New funding of $9 million over five years was provided to Canadian Heritage.
• Racism and discrimination persist as barriers preventing the full social and economic participation of affected communities. They also negatively impact the mental health of racialized populations, and contribute to inequities in social and economic conditions that are linked to health.
• Through the Promoting Health Equity: Mental Health of Black Canadians Initiative, the Public Health Agency of Canada proposes a set of activities to support the development, implementation and evaluation of more culturally focused mental health programs in Black Canadian communities and strengthen the body of knowledge on effective approaches for improving the mental health of Black Canadians.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Grants and Contributions	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	2	194	144	338	39	377	1,765	2,142
Total Funding	2	194	144	338	39	377	1,765	2,142

Allocation of Funds

Approximately 10-12 multi-year projects in Black Canadian communities across Canada will be funded over the course of the 5-year funding window.

Anticipated Results

Public Health Agency of Canada investments are intended to foster positive mental health, by improving the social environments in which Black Canadians live, work and play – which in turn strengthens social well-being. Social well-being is a key, evidence-based measure of positive mental health.

Monitoring and Measurement

N/A

Evaluation

Date: February 21, 2020

Prepared by:

Janet Marth
Senior Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Mental Health of Black Canadians: Incubator projects (8 total; GAs signed; 5 already announced; 3 to be announced TBC)

Still to be announced

Already announced

Promoting Health Equity: Four Mental Health of Black Canadians Fund
Implementation Stream Projects (8 total; all CAs signed; announcement Feb 13, 2020 TBC)

The drug overdose crisis in Canada: Funding for actions to protect Canadians and prevent overdose deaths

Issue

Why is the Public Health Agency of Canada (PHAC) requesting $1.9 million to support actions to protect Canadians and prevent overdose deaths in the 2019–20 Supplementary Estimates (B)?

Response

• Canadians are facing one of the most severe public health crises in recent history. Opioid-related overdoses and deaths are becoming increasingly devastating and impacting families and communities across the nation.
• From January 2016 to June 2019, there were more than 13,900 apparent opioid-related overdose deaths in Canada.
• This funding, announced in July 2019, will be used to support projects that mobilize evidence to reduce barriers and enhance pathways to care for people who use drugs; provide needed data and infrastructure to support the development of early warning systems, and to expand understanding of problematic substance use and the impacts on the health and well-being of Canadians.

Key facts

• Through this investment, the Public Health Agency of Canada was allocated $9.2M over 3 years ($1.9 million in 2019-20; $5.1 million in 2020-21; and, and $2.2 million in 2021-22), to establish a grant and contribution program that will mobilize evidence to reduce barriers and enhance pathways to care for people who use drugs, and expand and enhance surveillance on substance-related harms and their risk factors.
• This funding is in addition to existing Public Health Agency of Canada investments of $4.2 million per year to combat the opioid crisis.

Background

• In July 2019, the Government announced a new commitment of $76.2 million over 5 years, beginning in 2019-20, to further advance initiatives aimed at addressing the opioid crisis and rising harms from methamphetamine use. This brought the total recent investment to more than $100 million, including $30.5 million from Budget 2019. The total investments now include:
  • $41.8 million to scale up key life-saving measures in underserved communities,
  • $33.6 million to mitigate the impacts of the illegal drug supply, and
  • $31.3 million to identify and address emerging drug threats, and the growing use of methamphetamines.
• Canadians are facing one of the most severe public health crises in recent history. Opioid-related overdoses and deaths are becoming increasingly devastating and impacting families and communities across the nation. Between January 2016 and June 2019, there were more than 13,900 apparent opioid-related overdose deaths in Canada. The majority of these deaths involved highly potent synthetic opioids like fentanyl, which has increasingly contaminated the illegal drug supply in Canada, putting people who use drugs at high risk of a fatal overdose.
• While the administration of health services typically falls under provincial jurisdiction, the federal government, through the Public Health Agency of Canada works to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health. Therefore, given the acute and severe nature of the crisis, the federal government has opted to intervene to help support Provinces and Territories by removing obstacles and accelerating the expansion of critical services.
• The impact of the crisis has been significant. For example, life expectancy at birth for males has remained the same for 2016, 2017 and 2018. This was largely attributable to the opioid crisis.
• The complexity of the crisis extends beyond opioid use. A variety of substances is often involved in opioid-related deaths; approximately 70% of unintentional apparent opioid-related deaths between January 2016 and June 2019 involved one or more non-opioid substance, such as benzodiazepines, cocaine, or methamphetamines. In light of the dire nature of the situation, the federal government has made significant investments to help address the crisis.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Grants and Contributions	Total
Existing Funding	16	1,546	1,337	2,883	309	3,192	1,000	4,192
SUPPS B – 2019–20	6	568	848	1,416	153	1,569	300	1,869
Total Funding	22	2,114	2,185	4,299	462	4,761	1,300	6,061

Allocation of Funds

Funding will target immediate measures to address persistent gaps in harm reduction and reduce overdose deaths. Specifically, funding will support efforts in underserved communities to expand access to a safe supply of prescription opioids to people suffering with problematic opioid use, as well as support better access to opioid overdose response training and to naloxone—a life-saving medication that can stop or reverse an opioid overdose.

Anticipated Results

This proposal is expected to advance the federal government’s comprehensive, collaborative, and evidence-based response to the opioid crisis in order to reduce opioid-related harms and deaths.

Monitoring and Measurement

• Pathways to Care:# of projects funded under the Supporting Pathways to Care for People who Use Drugs (quantitative).
• % of participants (individuals working within the targeted systems/settings) reporting improved knowledge/skills that can help reduce barriers to care for people who use drugs (quantitative).
• Nature of changes to policy and practice within the system (qualitative).

Evaluation

N/A

Date: February 21, 2020

Prepared by:

Janet Marth
Senior Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Supporting Pathways to Care for People Who Use Drugs

Each of the six proposed projects will help achieve systems-level changes that will improve pathways and reduce barriers to care for people who use drugs.

Collectively, these six projects represent an investment of $3,327,258 over two years, and will leverage an additional $1,125,485 in financial and in-kind contributions from project partners and collaborators.

Project funding is anticipated to start April 1, 2020, with funding ending in March 31, 2022.

• $614,503 in contribution funding to the BC Centre for Disease Control, Provincial Health Services Authority (Harm Reduction and Hepatitis Division) to co-develop new policies and guidelines to ensure that all individuals entering correctional centres are offered and will undergo testing for sexually transmitted and blood borne infection (STBBI). With people who use drugs having a particularly high risk of contracting STBBI’s, as well as going undiagnosed/untreated, these new policies and guidelines will give people who use drugs entering correction facilities the opportunity to receive testing and treatment in a safe and compassionate manner.
• $391,199 in contribution funding to Sherwood Park Family Physicians NPC to create new pathways to care and attachment protocols for people who use methamphetamines in Alberta as they move through different components of the health system by leveraging existing proven practices. With the number of people seeking treatment for methamphetamines rapidly increasing, this project represents an innovative way to ensure people who use methamphetamines have barrier-free, continued care as they move through the health care system.
• $412,850 in contribution funding to NorWest Community Health Centres to adapt Rapid Access Addiction Medicine (RAAM) clinics in Northern Ontario to meet the unique needs of Northern Ontario communities. RAAM clinics offer a zero-barrier, walk-in care for people who use drugs without a referral or formal appointment. This project will leverage the success of RAAM clinics and adapt the success to the unique needs of Northern Ontario communities, where substance use rates are high.
• $472,908 in contribution funding to the Nova Scotia Health Authority to reduce stigma among healthcare providers who care for people who use drugs and enhance public health follow-up procedures for people who use drugs who have been newly diagnosed with HIV and/or Hepatitis C Virus. People who use drugs are at an elevated risk of HIV/HCV, this program represents a great potential to ensure they are provided with proper follow-up procedures in a compassionate, caring way.
• $631,186 in contribution funding to Southwest Ontario Aboriginal Health Access Centre to deliver Indigenous cultural safety training to health providers, managers and leaders working within five hospitals in the Erie St. Clair Region in Ontario. By providing cultural safety training addressing Indigenous specific bias and discrimination in the health care system, this program will help improve the healthcare experience for Indigenous people who are affected by substance use.
• $804,612 in contribution funding to the University of British Columbia to advance equity-oriented health care for people who use substances in Ontario and British Columbia. Enhanced resources, training modules and related strategies will better promote equity within health care systems and decrease barriers related to stigma and discrimination among people who use substances.

Funding to support the Métis Nation in gathering health data and developing a strategy

Issue

Why is the Public Health Agency of Canada (PHAC) requesting $1.2 million to support the Métis Nation in gathering health data and developing a health strategy in the 2019-20 Supplementary Estimates (B)

Response

• There is currently limited Métis Nation-specific health data and significant challenges with existing data sources.
• Budget 2018 announced $6 million over 5 years to support the Métis Nation in gathering health data and developing a health strategy.
• The Public Health Agency of Canada, through a funding envelope of $1.2 million annually for the next 5 years, will help the Métis Nation, the Government of Canada, as well as Provinces and Territories, understand the Métis Nation’s health needs in order to better inform evidence-based policies, programs and services.

Key facts

• A Memorandum of Understanding (MOU) on Developing a Canada-Métis Nation Health and Wellness Accord was signed on August 21, 2018, aimed at improving health outcomes for the Métis Nation. The MOU identified 13 themes to be addressed and includes Métis Health Research, Surveillance, Knowledge and Evaluation.
• While Métis Nation health research, surveillance, knowledge and evaluation is identified as a specific theme in the MOU, up-to-date and comprehensive Métis Nation health data should also be viewed as foundational to support the evidence-based policy and program decision-making in the remaining 12 themes identified in the MOU.

Background

• This funding will help the Métis Nation, the Government of Canada, as well as Provinces and Territories, understand the Métis Nation’s health needs in order to better inform evidence-based policies, programs and services.
• This is not a new named grant. It is an increase to an existing grant authority under Population Health.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Grants & Contributions	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	0	0	0	0	0	1,200	1,200
Total Funding	0	0	0	0	0	0	1,200	1,200

Allocation of Funds

• In the absence of a horizontal funding mechanism that fulfills the Canada-Métis Nation Accord’s commitment to a renewed fiscal relationship with the Métis Nation, the funding announced in Budget 2018 will allow PHAC to enter into six separate five-year grant agreements with the MNC and its five Governing Members: Métis Nation of Ontario (MNO), Manitoba Metis Federation (MMF), Métis Nation – Saskatchewan (MN-S), Métis Nation of Alberta (MNA, and Métis Nation British Columbia (MNBC).
• The use of grants allows for reduced administrative requirements and refrains from extensive financial oversight which is counter to a government-to-government relationship.

Anticipated Results

The funding will enable the MNC and each of the Governing Members to increase their capacity to gather and analyse health data. Specifically, the proposed initiative will enable the Métis Nation to extrapolate Métis Nation-specific health data from existing databases and analyse them in order to identify the health needs of Métis Nation citizens, including those of its vulnerable populations. Where feasible, this data will include socio-economic identifiers such as sex, age, etc. However, the extent to which this analysis will include these factors is dependent upon the availability of this information in existing datasets.

1. # of human resources working on health data as a result of this funding
2. # of Governing Members with collaborative partnerships in place
3. # of new collaborative partnerships established to support health data
4. # of formalized agreements (e.g. Information Sharing Agreements) put in place to gather and analyse health data
5. # of new technologies or technological upgrades (e.g. software, databases) implemented to support gathering and analysis of health data
6. # of knowledge translation products developed
7. # of times knowledge translation products and analysis of health data are shared by the MNC and Governing Members through various activities such as conferences, forums, and meetings
8. # of times MNC and Governing Members’ health data analysis is used as evidence to inform their policies, programs, and proposals

Monitoring and Measurement

Although each of the recipients will be undertaking different activities to reflect their distinct needs, priorities and circumstances, recipients will be reporting on a common set of performance indicators.

Evaluation

A decision on the need to evaluate this initiative will be done as part of the annual departmental evaluation planning exercise and based on the assessed needs, risks and priorities at that time.

Date: February 21, 2020

Prepared by:

Janet Marth
Senior Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Métis Data Project Descriptions

March 2020

Métis National Council

Fund:  Métis Nation Health Data and Strategy Program
Recipient: Métis National Council
Title: Métis National Council – Health Data Project
Description: The Métis National Council (MNC) will coordinate communications among Métis Nation Governing Members, the federal government and other partners. They will also play a lead role in facilitating and fostering ongoing knowledge exchange among Governing Members and other government partners including the Government of Canada in support of evidence-based Metis Nation health policy and decision-making.
Amount: $600,000
Duration: 59 months

Manitoba Métis Federation

Fund:  Métis Nation Health Data and Strategy Program
Recipient: Manitoba Métis Federation
Title: Measuring Métis Health Status in Manitoba through Métis Regional Health Survey: Reclaiming our Health
Description: Manitoba Métis Federation (MMF) will be using this funding, announced in Budget 2018, to increase the capacity for health information sustainability and to build a Métis-specific health information database to enhance data management (collection, processing and storage). MMF will also communicate strategic Métis health information to Manitoba health governing bodies to provide a basis for policy, fiscal responsibility and improved Métis population health.

MMF will also pilot the first Métis health and chronic disease Regional Health Survey. The survey will collect information on health status, chronic disease prevalence and health care utilization data. MMF will design the survey to obtain data representative of various ages for Métis population at the provincial level.
Amount: $1,350,000
Duration: 59 months

Métis Nation of Alberta Association

Fund:  Métis Nation Health Data and Strategy Program
Recipient: Métis Nation of Alberta Association
Title: Métis Nation Alberta – Building Health Capacity
Description: Métis Nation Alberta (MNA) will use funding announced in Budget 2018 to increase capacity to expand upon and undertake Métis specific health surveillance and research. Knowledge sharing with MNA citizens, programs, and services will also be a prioritized component of this funding.
Amount: $1,349,826
Duration: 59 months

Métis Nation of Ontario 

Fund:  Métis Nation Health Data and Strategy Program
Recipient: Métis Nation of Ontario 
Title: Métis Nation of Ontario – Health Data Submission
Description: Métis Nation of Ontario  (MNO) will be using the funding announced in Budget 2018 to put in place long-term surveillance systems to track Métis health status and needs. These surveillance systems are needed to guide Métis Nation health policy development and service delivery. In addition, MNO will work with the Institute for Clinical Evaluative Sciences in Ontario (ICES) to analyse both the MNO Registry and MNO Household Survey (conducted in May 2018).
Amount: $$675,000   
Duration: 59 months

Métis Nation Saskatchewan

Fund:  Métis Nation Health Data and Strategy Program
Recipient: Métis Nation Saskatchewan
Title: Métis Nation-Saskatchewan – Health and Well-Being Data Project
Description: Métis Nation Saskatchewan (MNS) will be using the funding announced in Budget 2018 to develop a Métis Health Data Strategy and build capacity for a sustainable health data surveillance system in support of Métis Nation research and policy development. They will ensure that the necessary partnerships and resources are in place to gather and analyse health data related to their citizens. Métis Nation-specific health data will provide evidence to further inform policies, programs, and health service delivery that is culturally responsive with the ultimate goal of improving health outcomes for the Métis Nation.
Amount: $1,350,000
Duration: 59 months

Background information to understand our royalties profile over the past 5 years

TB Policy Guidance:

A 1993 TB decision approved the practice of authorizing the Agency to receive, through Supplementary Estimates, an annual appropriation equal to all such revenues, which the Agency had remitted to the Consolidated Revenue Fund.

Also specified by TBS is that the funds are intended to be used toward the costs associated with incentive awards for technology transfer and other technology transfer activities undertaken by the Agency (intended to offset costs of protecting and marketing intellectual property, as well as paying royalty-based awards to public sector inventors).

Considerations:

PHAC consulted (April 2015) with TBS and took a look at the authorities and can confirm that we can receive, via Supplementary Estimates, the revenues remitted to the Fiscal Framework arising from royalties for intellectual property - provided TBS receives a CFO attestation.

The Department of Finance would need to approve a reprofile request for PHAC to access the funding over multiple fiscal years instead of all in the year following the remittance. PHAC would need to complete a reprofile request as per the regular ARLU process.

From a legal perspective there appears to be no limitations on how PHAC can use the licensing revenues. The only requirement is that PHAC obtains the approval of the TB to bring the funding into reference (via the estimates process).

Recommendation:

It is recommend that we work with both TBS and Finance to have the licensing revenues returned over multiple years in order to invest progressively.

Summary table:

Phac royallties from 2014-15 to 2018-19

Year	Royalties
2014-2015	3,790,735
2015-2016	2,497,410
2016-2017	23,391
2017-2018	121,240
2018-2019	218,182
Total	$6,650,958

Reinvestment of royalties from intellectual property

Issue

Why is Public Health Agency of Canada (PHAC) reinvesting $218,200 of royalties in the Supplementary Estimates (B)?

Response

• Royalties earned in the prior year for intellectual property generated by the Public Health Agency of Canada are permitted to be re-invested annually.
• These Royalties are earned through licensing of intellectual property such as the Ebola vaccine.
• The majority of this funding is reinvested in research and innovation and 35% is shared among the inventors of the intellectual property.

Key facts

• Pursuant to the 1993 decision of the Treasury Board respecting the retention of royalties and fees from the licensing of Crown-owned intellectual property, Public Health Agency of Canada (PHAC) is authorized to receive, through Supplementary Estimates, an annual appropriation equal to all such revenues that the PHAC had remitted to the Consolidated Revenue Fund in the previous year.
• The Public Health Agency of Canada Intellectual Property Policy guides the development, ownership and stewardship of intellectual property at PHAC.
• PHAC employees involved in the conception, discovery or development of scientific or technological innovations are eligible to share in financial awards arising from these inventions or innovations up to a lifetime maximum of $250,000.
• Proceeds collected in fiscal year 2018-2019 totalled $218,182. The majority of this funding returns to the PHAC to reinvest in research and innovation; the remaining 35% is shared among seven inventors (current and former public servants).

Background

• The Office of Intellectual Property Management & Business Development is responsible for ensuring that all intellectual property created by the PHAC is prudently managed.
• PHAC collects licensing revenues and processes awards to inventors in a manner that is consistent with federal policies and with Section 10 of the Public Servants Invention Act.

The 2018-19 royalty income totalled $218,200 of which:

• $201,300 was received as milestone and/or minimum royalty payments from licenses to the rVSV Vaccine technology against viral hemorrhagic fever viruses ($163,200 for the vaccine against Ebola; $25,000 for a vaccine against Lassa; and $13,000 for license against Marburg & Sudan)
• $15,800 was for sales of diagnostic reagents using PHAC monoclonal antibodies
• $600 for publishing licenses to “Nobody’s Perfect” parenting guides
• $500 for minimum royalty payments from a license to Haemophilus Influenza B vaccine technology

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	G&Cs	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	2.3	215.2	217.5	0.6	218.1	0	218.1
Total Funding	0	2.3	215.2	217.5	0.6	218.1	0	218.1

Allocation of Funds

The majority of this funding returns to the PHAC to reinvest in research and innovation; the remaining 35% is shared among inventors.

Date: February 21, 2020

Prepared by:

Janet Marth
Senior Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Transfer from the National Research Council of Canada to the Public Health Agency of Canada for genomics research and development

Issue

Why is National Research Council of Canada (NRC) transferring $844,735 to Public Health Agency of Canada (PHAC) for Genomics Research and Development in the 2019-20 Supplementary Estimates (B)?

Response

• The National Research Council (NRC) of Canada coordinates an annual allocation of $3.98 million of Genomics Research and Development Initiative funding for inter-departmental collaborative projects along shared priorities and common goals.
• Funding of $844,735 this year from the NRC supports the Public Health Agency’s role in the two current projects:
  • $773,735 to produce new genomic-based tools that provide a fuller understanding of contributions from the food chain to Antimicrobial Resistance in pathogens that pose a high risk to human and animal health; and
  • $71,000 to develop innovative approaches to identify organisms associated with environmentally transmitted diseases.

Key facts

• The Genomics Research and Development Initiative (GRDI) provides the authority for NRC to redistribute the funds to participating departments/agencies to support integrated federal research projects that address horizontal priorities beyond the mandate of a single department.

Antimicrobial Resistance

• NRC, Health Canada, PHAC, Canadian Food Inspection Agency (CFIA), Agriculture and Agri-Food Canada (AAFC) collaborate in the Antimicrobial Resistance (AMR) project.
  • The project supports integrated research that is improving our understanding of the contribution of food and food production methods to AMR that is of human clinical importance, and will inform policies and actions to control AMR.
• At the Agency, research funded by the AMR project is developing new tools to analyse and share complex data to help to identify the most significant real-world transmission pathways for AMR, and thereby also identify effective intervention points.

EcoBiomics Project

• NRC, Natural Resource Canada, Department of Fisheries and Oceans, Environment and Climate Change Canada, AAFC, CFIA and PHAC collaborate in the EcoBiomics project that is developing innovative tools to better understand the living systems in water and soil.
• In the environmental project, Agency researchers leverage samples supplied by natural resource-based departments to develop new methods to detect insect vectors that spread disease and to detect waterborne diseases. This work will inform approaches to adapt to the impact of changing infectious disease risks driven by climate change.

Background

• AMR is recognised internationally as a growing threat to human and animal health that if left unchecked has the potential for enormous detrimental impact on health and on Canada’s economy. The World Health Organisation recognises AMR as a “One Health” issue because AMR bacteria can move between animals, humans and the environment. Consequently, an understanding of AMR in each of those sectors is needed to develop the most effective responses to prevent and control AMR.
• Climate change is recognised as a threat to Canada’s ecosystems, managed resources, and agriculture, as well as the health of humans and animals. Consequently, increasing our understanding of changes to biodiversity is important to monitoring the impact of climate change and informs our actions to control risks, adapt and develop resiliency.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	G&Cs	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	0	844.7	844.7	0	844.7	0	844.7
Total Funding	0	0	844.7	844.7	0	844.7	0	844.7

Allocation of Funds

• $773,735 has been allocated to Antimicrobial Resistance project.
• $71,000 has been allocated to the EcoBiomics project.

Monitoring and Measurement

NRC is responsible for reporting on this project. Each interdepartmental project team provides a collaboratively drafted annual progress report directly to the NRC for that purpose.

Date: February 21, 2020

Prepared by:

Janet Marth
Senior Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Transer from the department of national defence to public health agency for the canadian safety and security program - tabling of the 2019–20 supplementary estimates (b)

Issue

Why is the Department of National Defence (DND) transferring $240,000 to Public Health Agency of Canada (PHAC) funding for the Canadian Safety and Security Program (CSSP) in the Supplementary Estimates (B)?

Response

• The Canadian Safety and Security Program (CSSP) is a federally-funded program led by Defence Research and Development Canada’s Centre for Security Science, in partnership with Public Safety Canada.
• This funding, provided through the CSSP, to enhance Canada’s capability to prepare for, prevent and respond to chemical, biological, radiological-nuclear and explosive terrorist threats.
• In addition, the CSSP is mandated to create and support federal laboratory groups by acquiring the technologies necessary to fill the gaps in their ability to mitigate the above threats.
• This funding transfer of $240,000 will be used by the Public Health Agency of Canada to make an acquisition of biosecurity equipment that can be deployed and is capable of detecting disease-causing agents.

Key facts

• Funding will acquire a biological surveillance system which is a deployable instrument capable of detecting disease causing agents which are important to biological security. This machine will be used by the Microbiological Emergency Response Team in Canada’s National Microbiology Laboratory for detecting disease causing agents.

Background

• In the event of an emergency that poses a risk to public health, the Public Health Agency of Canada, under the co-ordination of Public Safety Canada and with other Government departments such as Health Canada, plays a key role in protecting the health and safety of Canadians in the event of a chemical, biological or radio-nuclear emergency.
• The Agency's Microbiological Emergency Response Team (MERT) can be deployed to a planned event and provide specialized detection and identification services for emerging bacterial diseases.
• The MERT is also responsible for developing and maintaining national emergency response plans, responding to bioterrorism or infectious disease outbreaks in Canada and internationally.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	G&Cs	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	0	240	240	0	240	0	240
Total Funding	0	0	240	240	0	240	0	240

Allocation of Funds

Acquisition of equipment.

Date: February 21, 2020

Prepared by:

Janet Marth
Senior Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Transfer from Health Canada to the Public Health Agency of Canada to support activities related to economic costing of climate change and health

Issue

Why is the Public Health Agency of Canada (PHAC) receiving $179,562 from Health Canada to support activities related to economic costing of climate change and health in the 2019–20 Supplementary Estimates (B)?

Response

• To date, the strong connections between health, economic and climate action have not been well explored in policy and practice and there is limited information on climate change’s economic costs and stresses to health systems.
• To address this gap, Health Canada is transferring funding of $179,652 to the Agency’s International Health Grants Program to be used as a grant to the World Health Organization in order to support work to develop tools to aid in the assessment of the economic impact that climate change has on health and health systems.
• Health Canada is using the Public Health Agency’s platform through its international health grant program to transfer $ 179,562 to the World Health Organization to support two projects.

Key facts

• Health Canada (HC) does not have an authority to transfer funds to international organizations directly. PHAC manages the International Health Grants Program (IHGP), a mechanism by which international projects aligning with the priorities of the Health Portfolio can be funded.
• Health Canada’s funds are from Climate Change and Health Adaptation Capacity Building Contribution Program, which is part of a Treasury Board Submission approved in 2017 (“Climate Change and Health Adaptation: Information and Action for Resilience”).

Background

• Climate change is expected to magnify existing health risks and introduce novel ones. Health decision makers need information on the costs of climate change impacts on health and on health systems in order to make decisions that are more informed on adaptation strategies to protect health.
• Taking action on climate change carries significant health, social and economic benefits. These include reduced risk to human health that results from adaptation to global warming, reduced greenhouse gas emissions and improved air quality, and better economic outcomes from reduced financial costs to health systems.
• In the past, similar grants were provided to the World Health Organization to:
  • Develop and consult on tools for assessing climate change vulnerability of healthcare facilities;
  • Develop targeted guidance for prioritization of available health adaptation options, and indicators for measuring overall health system resilience; and
  • Develop a framework for monitoring and surveillance of climate-sensitive diseases.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Grants and Contributions	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	0	0	0	0	0	179.6	179.6
Total Funding	0	0	0	0	0	0	179.6	179.6

Allocation of Funds

• The grants received by the World Health Organization will be used to fund the following activities:
  • Development of an overall health, climate change and economic framework to help policymakers understand the health costs, savings and gains of climate actions;
  • Collection and review of existing tools for health, climate and economic assessment; and
  • Pilot testing the framework and tools via policy simulation exercises with 2-4 countries.

Anticipated Results

• Through this project, the World Health Organization seeks to promote a more coherent approach to health, climate change and economics, and champion assigning a higher priority for health in climate change mitigation and adaptation policies by providing a clear and common understanding of how these considerations should be jointly assessed.
• The organization also aims to improve global practices in selecting health adaptation options, and in promoting actions that improve health outcomes and climate change mitigation.

Date: February 21, 2020

Prepared by:

Shane Sabga Intermediate Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Transfer from Public Services and Procurement Canada to Public Health Agency of Canada related to the implementation and support of a cluster management office as part of the Federal Sciences and Technology Infrastructure Initiative

Issue

Why is the Public Health Agency of Canada receiving $177,678 from the Public Services and Procurement Canada to support the implementation and support of a cluster management office as part of the Federal Sciences and Technology Infrastructure Initiative in the 2019–20 Supplementary Estimates (B)?

Response

• Public Health Agency of Canada is participating in the Laboratories Canada Initiative formerly announced as the Federal Science and Technology Infrastructure Initiative in Budget 2018.
• Departments have been clustered around a series of common science objectives and are in the planning phase for this initiative led by Public Services and Procurement Canada.
• An annual amount of $177,678 for the next three years is being transferred to the Agency to perform science planning and collaboration work under the regulatory and security science cluster.

Key facts

• The Public Health Agency of Canada (PHAC) has received funding to lead some of the science planning / collaboration work relating to the RSS cluster in Guelph, Ontario.
• PHAC is participating in one Phase 1 project called “The Regulatory and Security Science Cluster” (RSS). This project is led by the Canadian Food Inspection Agency (CFIA) with five partnering departments: Agriculture and Agri-Food Canada (AAFC), Canadian Border Services Agency (CBSA), National Research Council Canada (NRC), Health Canada (HC) and PHAC.

Background

• Formerly know as the Federal Sciences and Technology Infrastructure Initiative, now called the Laboratories Canada initiative will create a world-class, national network of federal laboratories to support evidence-based decision-making, collaboration with partners, and innovation in core program delivery, including regulatory responsibilities.
• Laboratories Canada is an ambitious 25-year plan to revitalize federal science.
  • Whole-of-government, transformative initiative
  • Driven by science outcomes.
• This initiative represents a significant opportunity to create positive and lasting change, to better support and enable federal science now and into the future.
• Laboratories Canada will:
  • create a framework for collaboration that will drive the federal science community and the next generation of scientists;
  • develop infrastructure and greater access to common tools to enable leading-edge science; and,
  • leverage partnerships with academia, industry, other governments, and key players in research and innovation.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Total
Existing Funding	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	0	177.7	177.7	0	177.7	177.7
Total Funding	0	0	177.7	177.7	0	177.7	177.7

Allocation of Funds

• The funding will be used to coordinate PHAC’s participation in the Laboratories Canada initiative. It will support timely responses to information requests from Laboratories Canada and the Regulatory and Security Science Cluster.

Anticipated Results

To support effective coordination to meet Laboratories Canada execution schedule and PHAC’s requirements.

Monitoring and Measurement

Diligent financial management will be used to monitor the expenditures against the funding budget.

Date: February 21, 2020

Prepared by:

Janet Marth
Senior Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Transfer from Health Canada to the Public Health Agency of Canada for the OECD work on chemicals management and pesticides

Issue

Why is the Public Health Agency of Canada (PHAC) receiving $150,000 from Health Canada to support activities related to chemical management and the assessment of pesticides in the 2019–20 Supplementary Estimates (B)?

Response

• Environmental factors such as air, water, soil pollution, chemical exposures and climate change pose significant risks to human health.
• To address this gap, Health Canada is transferring funding of $150,000 to the Agency’s International Health Grants Program to be used as a grant to the Organisation for Economic Co-operation and Development in order to support health-related policy, technical and scientific activities that help Canada maintain the highest standards for the sound management of chemicals, including pesticides, to protect the health and safety of Canadians and their environment.
• Health Canada is using PHAC’s platform through the International grants program to transfer the money to the OECD project.

Key facts

• Specific Areas of work in which Health Canada is engaged include:
  • The development of standard test guidelines;
  • Furthering the development of novel approaches and methods for risk assessment; and
  • Collaborative work to overcome joint challenges related to emerging issues in chemical management.
• Health Canada does not have an authority to transfer funds to international organizations directly. PHAC manages the International Health Grants Program, a mechanism by which international projects aligning with the priorities of the Health Portfolio can be funded.

Background

• Through the Organisation for Economic Co-operation and Development (OECD), Health Canada is collaborating with international partners including the European Union, the United States and Australia on the science of chemicals management.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Grants and Contributions	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	0	0	0	0	0	150	150
Total Funding	0	0	0	0	0	0	150	150

Allocation of Funds

• $50,000 will be directed to the OECD’s Environmental and Safety Division to aid in the delivery of Canada’s Chemicals Management Plan and improve the health and safety of Canadians.
• $100,000 will be directed to the OECD’s working group on pesticides to support ongoing development and enhancement of approaches for the assessment of pesticides.

Anticipated Results

• The work supported by this grant will provide a venue to leverage Health Canada’s expertise by collaborating with other countries to:
  • Respond to and advance new and emerging science;
  • Overcome shared challenges and find robust solutions; and,
  • Increase the efficiency of chemicals management programmes for both industry and government.

Date: February 21, 2020

Prepared by:

Shane Sabga
Intermediate Financial Analyst, Resource Management and Analysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Transfer from Health Canada to Public Health Agency of Canada to develop international scientific advice on food allergens

Issue

Why is Health Canada (HC) transferring $110,000 to Public Health Agency of Canada (PHAC) to develop international scientific advice on food allergens in the 2019-2020 Supplementary Estimates (B)?

Response

• As knowledge on food allergens and their management continues to evolve, there is a need to review and revise the General Standard for the Labelling of Packaged Foods to include the evidence-based consumer understanding of allergens from scientific experts.
• To address this gap, Health Canada is transferring funding of $110,000 to the Agency’s International Health Grants Program to be used as a grant to the Food and Agriculture Organization of the United Nations to support efforts to update the list of food allergens included in the General Standard for the Labelling of Packaged Foods.
• Health Canada is using PHAC’s platform through the International grants program to transfer the money to the FAO project.

Key facts

• The list of foods and ingredients known to cause hypersensitivity was included in the General Standard for the Labelling of Packaged Foods (GSLPF) in 1999. Since then, there have been many scientific developments in food allergens, including further research being conducted on adverse health reactions of milk proteins.
• Health Canada (HC) does not have an authority to transfer funds to international organizations directly. PHAC manages the International Health Grants Program (IHGP), a mechanism by which international projects aligning with the priorities of the Health Portfolio can be funded.

Background

• The Food and Agriculture Organization (FAO) is a specialized agency of the United Nations that leads international efforts to defeat hunger. The organization seeks to achieve food security for all and ensure that populations worldwide have regular access to enough high-quality food to lead active and healthy lives. With over 194 member states, FAO works in over 130 countries worldwide. The FAO facilitates partnerships for food and nutrition security, agriculture and rural development between governments, development partners, civil society and the private sector.
• The FAO facilitates partnerships for food and nutrition security, agriculture and rural development between governments, development partners, civil society and the private sector. Canada is a member state of the FAO.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Grants and Contributions	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	0	0	0	0	0	110	110
Total Funding	0	0	0	0	0	0	110	110

Allocation of Funds

• The grant will be used to support the following activities:
  • To establish an ad-hoc joint FAO/WHO Secretariat to prepare technical documents, oversee and facilitate meetings and draft reports;
  • Consultant support for the Secretariat;
  • Developing a risk assessment for food allergens, including data analysis and modelling, to validate and update the list of foods and ingredients in the General Standard for Labelling of Packaged Foods (GSLPF);
  • Facilitating group discussions between multi-disciplinary experts to review and validate risk assessment, scientific information and opinions; and
  • Developing, publishing and distributing meeting and technical reports summarizing expert findings and conclusions.

Anticipated Results

Canada (as a member state of the FAO) will be able to leverage advice from the work performed to support risk management decisions and conduct their own risk assessments. More importantly, the technical guidance will help inform policy and program development on food sensitivities and/or cross-contamination in Canada.

Date: n/a

Prepared by:

Shane Sabga
Intermediate Financial Analyst, Resource Management and Analysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Transfer from Health Canada to Public Health Agency of Canada for the United Nations Office of Drugs and Crime

Issue

Why is Health Canada transferring $75,000 to Public Health Agency of Canada for the United Nations Office of Drugs and Crime in the 2019-20 Supplementary Estimates (B)?

Response

• A key priority for Canada is addressing the stigma associated with problematic substance use and substance use disorders to help ensure people who use drugs are treated with respect.
• In 2018, Canada sponsored a resolution entitled, “Promoting non-stigmatizing attitudes to ensure the availability of, access to and delivery of health, care and social services for drug users” that was adopted by consensus and co-sponsored by 19 countries at the United Nations Commission on Narcotic Drugs.
• To support this priority, Health Canada is transferring funding of $75,000 to the Agency’s International Health Grants Program to be used as a grant to the United Nations Office of Drugs and Crime to cover the costs of the reporting requirements outlined in the stigma resolution, which commits member states to report on their activities and initiatives to reduce stigma faced by people who use drugs.

Key facts

• Health Canada (HC) does not have an authority to transfer funds to international organizations directly. PHAC manages the International Health Grants Program (IHGP), a mechanism by which international projects aligning with the priorities of the Health Portfolio can be funded.
• The stigma resolution indicates that by 2020, Member States will report on their activities and initiatives within their respective jurisdictions on what they have done to reduce stigma faced by people who use drugs.
• To carry out this work, the resolution indicates that the United Nations Office of Drugs and Crime (UNODC) will need funding to cover salary costs associated with gathering this information from Member States and for developing a report that will be shared at United Nations Commission on Narcotic Drugs in 2020.

Background

• In 2018, Canada sponsored a resolution entitled, “Promoting non-stigmatizing attitudes to ensure the availability of, access to and delivery of health, care and social services for drug users” that was adopted by consensus and co-sponsored by 19 countries at the United Nations Commission on Narcotic Drugs (CND).
• Canada has held Commission on Narcotic Drugs (CND) membership since 2006, and was recently re-elected for another term (until 2022). As the competent authority for the UN drug control conventions, HC attends CND annually and leads the Canadian delegation
• Through the Canadian Drugs and Substances Strategy, Canada is pursuing a more balanced, evidence-based approach to drug policy, which includes prevention, treatment, enforcement and harm reduction.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Grants and Contributions	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	0	0	0	0	0	75	75
Total Funding	0	0	0	0	0	0	75	75

Allocation of Funds

• Grant funding to the United Nations Office on Drugs and Crime will support the following key activities:
  • Distribution of an online questionnaire to the Member States to obtain information on what they have done to reduce stigmatising attitudes faced by people who use drugs prior to and after the adoption of the stigma resolution in 2018; and
  • Compilation and analysis of survey findings to develop a report that will be shared with Member States at the 63rd session of CND in March 2020.

Anticipated Results

• It is expected that this project will contribute to sharing information on best practices among CND Member States with respect to reducing the stigma surrounding people who use drugs.
• It will contribute to improving awareness of stigmatising attitudes and promoting initiatives countries can undertake to address the issue domestically.

Date: February 21, 2020

Prepared by:

Shane Sabga
Intermediate Financial Analyst, Resource Management and Analysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Transfer from Health Canada to Public Health Agency of Canada to expand health information in the Climate Atlas of Canada

Issue

Why is Health Canada transferring $75,000 to Public Health Agency of Canada to contribute to a climate change and health project with the Prairie Climate Center to develop health content in the Climate Atlas of Canada in the 2019-20 Supplementary Estimates (B)?

Response

• The Prairie Climate Centre (PCC) at the University of Winnipeg produces the Climate Atlas of Canada (“The Climate Atlas”), a national, bilingual, public education online tool to share information on climate change in Canada.
• Through its contribution to the Climate Atlas, Health Canada is supporting the addition to the Climate Atlas of new air quality and health information for Canadians. Using the transfer from Health Canada, the Public Health Agency of Canada will fund this work through their established, multi-year grant mechanism with the PCC.

Key facts

• Health Canada and PHAC both have a role to help Canadians maintain their health and to prepare for and adapt to new health risks resulting from climate change.
• Both Health Canada and PHAC identified an opportunity to add public health content to the Climate Atlas. PHAC funded the addition of content related to foodborne, infectious and zoonotic disease risks from climate change, and Health Canada funded content related to air quality and climate change.
• PHAC has an existing multi-year agreement with PCC to incorporate health messaging into their climate change public education tool. The transfer of funds to PHAC allows for increased efficiency and lessened administrative burden for the funding recipient (PCC).

Background

Program Objectives

• HC provides Canadians with information on health effects related to air quality. The PCC Climate Atlas is a highly effective tool to engage Canadians, and share health information related to air quality and effects of climate change on health risks.
• Presenting air quality and health information in the Climate Atlas will equip Canadians with the information they need to understand their health risks, make informed decisions, and take appropriate action to preserve and improve their health.
• The end result will be that new air quality and health information is available to Canadians through the Climate Atlas of Canada.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Grants and Contributions	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	0	0	0	0	0	75	75
Total Funding	0	0	0	0	0	0	75	75

Allocation of Funds

This transfer will ensure that the PCC agreement also includes Health Canada’s objectives for the Climate Atlas for 2019-20.

Anticipated Results

Canadians will be provided with information on health effects related to air quality.

Date: February 21, 2020

Prepared by:

Janet Marth
Senior Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Transfer to the Royal Canadian Mounted Police from the Public Health Agency of Canada for the performance of law enforcement records

Issue

Why is the Public Health Agency of Canada requesting to transfer $6,517 to the Royal Canadian Mounted Police for the performance of law enforcement records in the 2019–20 Supplementary Estimates (B)?

Response

• Human pathogens and toxins pose a small but significant risk to human health and safety, either through accidental or deliberate release.
• The Public Health Agency of Canada issues Human Pathogens and Toxins Act Security Clearances to individuals who work on Security Sensitive Biological Agents, a subset of biological agents that if misused can pose a risk to Canada’s national security.
• The purpose of the Human Pathogens and Toxins Act Security Clearance is to validate that those individuals are reliable and trustworthy, and do not pose a security or diversion risk by virtue of their access.
• Part of the validation process includes a Law Enforcement Record Check, which is conducted by the RCMP.
• The additional funding of $6,517 to the RCMP will be used to fund an anticipated increase in security checks this fiscal year due to the number of pending expiries.

Key facts

• Requirements for security screening have been in place since December 1, 2015.
• As of February 25, 2020, there are 493 individuals with a valid HPTA security clearance.
• PHAC processes approximately 35 new requests each fiscal year and security clearances are granted for up to 5 years.
• Due to pending expiries, PHAC is expecting to process approximately 133 security clearances for fiscal 2020-21. A further increase is anticipated for 2021-22.

Background

• The Public Health Agency of Canada (PHAC) is authorized, under the Human Pathogens and Toxins Act (HPTA) and Human Pathogens and Toxins Regulations (HPTR), to carry out verifications, checks and assessments of applicants for HPTA Security Clearances.
• One of these assessments, the Law Enforcement Record Check, is conducted by the Royal Canadian Mounted Police (RCMP) through a Service Level Agreement with PHAC. These assessments are a fee-for-service.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Total
Existing Funding	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	(4.9)	(1.6)	(6.5)	0	(6.5)	(6.5)
Total Funding	0	(4.9)	(1.6)	(6.5)	0	(6.5)	(6.5)

Allocation of Funds

The transfer of funds to the RCMP is part of a fee-for-service agreement the Agency has with the RCMP.

Date: February 21, 2020

Prepared by:

Janet Marth
Senior Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Transfer from Public Health Agency of Canada to the Canadian Institutes of Health Research to participate in the European Union Joint Programme – Neurodegenerative Disease Research

Issue

Why is the Public Health Agency of Canada (PHAC) requesting to transfer $58,333 to the Canadian Institutes of Health Research (CIHR) to participate in the EU joint programme on neurodegenerative disease research in the 2019–20 Supplementary Estimates (B)?

Response

• Approximately 50 million people are living with Alzheimer’s disease and related neurodegenerative disorders worldwide. This figure is expected to double every twenty years as the population ages.
• The European Union Joint Programme on Neurodegenerative Disease Research (JPDN) was established to better coordinate research efforts across countries and disciplines to more rapidly find causes, develop cures and identify better ways to care for people with neurodegenerative disease.
• This funding of $58,333 provides Canadian researchers the opportunity to participating in the JDPN.

Key facts

• The Canadian Institutes of Health Research (CIHR) is the Canadian lead for the European Union Joint Programme – Neurodegenerative Disease Research (JPND).

Background

• The JPND was established in order to better coordinate research efforts across countries to more rapidly find causes, develop cures and identify better ways to care for people with neurodegenerative disease.

Funding ($000’s) and FTE

Funding	FTE	Salary	O&M	Total Operating	EBP	Sub-total	Grants and Contributions	Total
Existing Funding	0	0	0	0	0	0	0	0
SUPPS B – 2019–20	0	0	0	0	0	0	(58)	(58)
Total Funding	0	0	0	0	0	0	(58)	(58)

Allocation of Funds

These funds will be transferred to CIHR to support the participation of Canadian researchers in the JPND.

Monitoring and Measurement

CIHR requires that all Nominated Principal Applicants for this funding opportunity submit an end of grant report that allows CIHR to: obtain information on the impact of CIHR programs; evaluate the impact of CIHR funding; and share the results of funded research with partners, the research community and the general public.

Date: February 21, 2020

Prepared by:

Janet Marth
Senior Financial Analyst, Resource Management and Anlysis, OCFO

Key Contact:

Tomasz Popiel
Director, Resource Management and Analysis, OCFO
613-793-1322

Approved by:

Carlo Beaudoin
Chief Financial Officer
613-948-5798

Additional Information

Current ASD Strategic Fund Projects

Autism Nova Scotia Society – 2019-2021

Funding: $599,599

Healthy Relationships, Sexuality & Autism (HRSA) program expansion across Atlantic Canada

The HRSA program is a curriculum that will increase knowledge about sexuality among adults with ASD to support the development of life skills needed to navigate healthy relationships.

Autism Ontario – 2019-2021

Funding: $524,431

Mental Health Matters

Two group-based programs will be adapted for adults with ASD and their caregivers that utilize tenets of cognitive behaviour therapy to teach wellness and coping skills.

Les Grands Ballets Canadiens de Montreal – 2019-2021

Funding: $184,167

La danse pour le mieux-etre

This program will offer free dance classes to individuals with ASD across various age groups. This project will improve the wellbeing of individuals with ASD, their families and caregivers through regular exercise and creative expression through dance in a safe and inclusive environment. It will also help to develop self-esteem and confidence, support the development of interpersonal relationships, and help individuals learn ways to identify and express their emotions.

York University – 2019-2021

Funding: $599,300

Autism Mental Health Promotion Project

This project will develop and disseminate bilingual mental health literacy resources for adolescents and adults with ASD, their families and service providers. The project will also implement an online mindfulness-based training intervention (will be available on the AIDE Network) and an in-person acceptance and commitment training intervention to improve participants’ ability to cope with stressors.

Jake’s House for Autistic Children – 2019-2021

Funding: $600,000

The Legends Mentoring Program Adult Expansion (LMPAE)

The LMPAE will match adults with ASD (age 18-30) with a trained mentor to participate in work-related experiences and provide individualised support to develop social, behavioural and employment-related skills.

Giant Steps School – 2019-2021

Funding: $599,392

Next Steps: Industry-Based Adult Education and Employment Initiative

This program will provide an adult vocational training program and vocational placements for individuals with ASD. The program will support the employment preparedness and success of individuals with ASD to obtain paid employment.

McGill University – 2019-2021

Funding: $600,000

Caregiver Skills Training (CST) Program

The CST program will provide evidence-based skills training for caregivers of children with ASD across four community-based demonstration sites and offer caregivers strategies and solutions that can address practical needs and challenges, positively affecting their quality of life.

Autism Resource Centre – 2019-2021

Funding: $518,964

Building Block Program: Transition Services for Indigenous Youth with ASD

The Building Block Program is an evidence-based, three-month pre-employment and life skills program that will teach Indigenous youth with ASD, ages 18 - 30, core workplace skills, independent living and social skills.

QP Notes

Antimicrobial resistance

Synopsis

Antimicrobial-resistant infections are becoming more frequent and increasingly difficult to treat. The antibiotics we rely on for common infections, such as pneumonia and strep throat, are becoming less effective, resulting in serious illness and death. Already, 1 in 4 bacterial infections are resistant to the first line of antibiotic treatment and in 2018 approximately 5,400 Canadians died from a resistant infection and there were an additional $1.4 billion in hospital costs.

Key messages

• Our Government recognizes that antimicrobial resistance is increasing worldwide and is posing a serious and growing threat to the Canadian healthcare system.
• We are acting to preserve the effectiveness of antibiotics that Canadians rely on and prevent the spread of drug resistant infections.
• The Government is supporting research, surveillance, awareness, and education measures.
• A pan-Canadian Action Plan on antimicrobial resistance will coordinate Canada’s response to AMR for greatest impact. We will continue to provide federal leadership to reduce antimicrobial resistance and protect the health of Canadians.

Background

Antimicrobial Resistance (AMR) is characterized by a decline in the effectiveness of antimicrobial drugs in treating an infection. Without effective antimicrobials, our ability to fight infectious diseases will significantly decline. For example: routine medical procedures, joint replacements and even chemotherapy for cancer patients, that depend on antibiotics, will become more risky for Canadians.

The Council of Canadian Academies released a report on November 12, 2019, commissioned by the Public Health Agency of Canada, that describes the serious threat of antibiotic resistance. Already, 1 in 4 bacterial infections are resistant to the first line of antibiotic treatment and last year approximately 5,400 Canadians died from a resistant infection. Projections of growth to 40 percent resistance by 2050 and 400,000 deaths are plausible according to these experts.

Government of Canada Actions and Investments

The Government of Canada outlined its commitment to addressing AMR in the Federal Framework on AMR and its supporting Action Plan. In July 2018, the first Progress Report on the Federal Action Plan was released and can be found at Canada.ca.In recognition of the global public health threat, the Government of Canada identified AMR as a priority in the Prime Minister’s mandate letter to the Minister of Health. With support from the Minister of Innovation, Science and Industry, the Minister of Agriculture and Agri-Food and the Minister of Environment and Climate Change, the Health Portfolio is responding to the serious and growing public health threat posed by antimicrobial resistance by developing and implementing actions with partners to preserve the effectiveness of the antimicrobials that Canadians rely on every day.

Recognizing that the federal government cannot reduce the threat of AMR alone and consistent with our international partners, the Government of Canada led efforts with provinces, territories, and external stakeholders to develop the pan-Canadian AMR Framework, which was released in September 2017. Work is currently underway on a pan-Canadian AMR Action Plan that will identify concrete actions, to address this complex issue across the human, animal health, and agri-food sector. It is being developed in consultation and with input from all partners. Its release is planned for 2020.

The Government of Canada is taking action to address AMR by:

• Strengthening surveillance systems to help identify new threats or changing patterns of AMR in humans and animals;
• Strengthening the stewardship of antimicrobials in human and veterinary medicine, as well as regulatory and policy changes governing human and veterinary drugs;
• Collaborating with national and international partners to advance policy, research and innovation in both Canada and abroad, including research on diagnostics, new antimicrobials and alternatives to the use of antimicrobials in human and veterinary medicine.

The Government of Canada has invested a total of $203 million in the past 10 years to support domestic action on AMR. More specifically,

• The Public Health Agency of Canada has invested approximately $50 million on AMR policy leadership, surveillance and stewardship over 10 years;
• The Canadian Institutes of Health Research has invested $125 million in AMR research over the past 5 years to strengthen research in areas such as antimicrobial discovery, target identification, alternatives, diagnostics, surveillance, and stewardship. CIHR also provides funding to Canadian scientists to participate in international AMR research efforts under the Joint Programming Initiative on Antimicrobial Resistance;
• Agriculture and Agri-Food Canada has invested more than $37 million over the last 10 years to support industry-led research initiatives to accelerate the pace of innovation and address some of the AMR challenges in agriculture;

Regulatory and Policy Changes

In May 2017, amendments to the Food and Drug Regulations related to AMR in the veterinary drug context were published in Canada Gazette, Part II. These new regulations are aimed at increasing antimicrobial stewardship and promoting the prudent use of medically important antimicrobials (MIAs) in animals by:

• Collecting antimicrobial sales information;
  • The data collection system has been implemented and the first year of data have been received and are being analyzed.
• Increasing the oversight of active pharmaceutical ingredients for veterinary use;
• Controlling the “own use” importation of veterinary drugs and;
• Facilitating access to low risk veterinary health products in order to increase animal health and welfare;

In support of these regulations, Health Canada has also undertaken complementary policy measures, which include:

• Removing growth promotion claims from MIA labels; and,
• Requiring all MIAs for animals be sold pursuant to a prescription from a veterinarian.

Health Canada requires AMR stewardship statements in the labelling of all antibiotics for human use to help increase awareness and encourage prudent use. Additionally, Health Canada released a Pathogens of Interest List that will help inform companies of the bacterial pathogens in most urgent need of innovative therapeutic products in Canada. Health Canada has also sponsored a challenge under the Innovative Solutions Canada program, where up to $1 million is available to innovators and entrepreneurs to support the development of new, easy-to-use and cost effective, point-of-care diagnostic tools to help combat the rise of AMR.

International Activities

In May 2015, the World Health Organization’s (WHO) member states, including Canada, endorsed the WHO Global Action Plan on AMR, which calls on countries to develop multisectoral national action plans to address AMR. Canada supports the ongoing collaborative leadership of the WHO, the World Organization for Animal Health, and the Food and Agriculture Organization of the United Nations, via a One Health approach, to address AMR.
At the United Nations General Assembly high-level meeting on AMR in September 2016, world leaders endorsed a political declaration that recognized the need for stronger surveillance systems, strengthened regulation of antimicrobials, improved awareness, and innovative alternative treatments and diagnostics.

In 2017, the Government of Canada also made a one-time investment of more than $9 million to support the World Health Organization’s Global Action Plan on AMR. This initiative aims to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them.

Parliamentary Business

The Standing Committee on Health (HESA) tabled their 16th Report entitled: A Study on the Status of Antimicrobial Resistance in Canada and Related Recommendations on May 1, 2018. The Government Response to the Committee’s report was tabled on July 18, 2018 and is available on-line at the House of Commons website.

PHAC Contact: Stephanie Jackson (613) 858-5861
PHAC Approved by: Kimberly Elmslie (613) 954-9663
CIHR Contact: David Marchand (613) 948-5802
HPFB Contact: Joan Kennedy (613) 608-3253
HPFB Approved by: Pierre Sabourin, ADM-HPFB (613) 957-1804
CFIA Contact: Andrea Lauzon (613) 773-5268
CFIA Approved by: Jaspinder Komal (613) 773-7472

Autism spectrum disorder

Synopsis

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by communication difficulties as well as social and behavioural challenges. The Government of Canada will work collaboratively with provinces, territories, families and stakeholders toward the creation of a national autism strategy.

Key messages

• The Government of Canada is committed to helping all Canadians with disabilities, including those with autism spectrum disorder, as well as those who care for them and provide much needed support.
• Our Government is working collaboratively with the provinces, territories, families, those with ASD, and stakeholder organizations, toward the creation of a national autism strategy.
• We are investing more than $54 million to help families with autism have access to credible information, training to seek employment, and tax credits to help with some of the costs related to caring for loved ones with disabilities.
• We have also invested close to $48 million in research in the past five years, to increase the understanding of ASD as well as the capacity to treat it effectively.

If pressed on the mandate letter

• I look forward to working collaboratively with provinces, territories, families and stakeholders toward the creation of a national autism strategy.

Background

Government of Canada Initiatives

Budget 2018 announced $20 million over five years (2018-2023) in funding to support two new initiatives: 1) The Autism-Intellectual-Developmental Disabilities National Resource and Exchange (AIDE) Network ($10.9 million/5 years) will be operational in March 2020 providing access to online resources, an inventory of services, supports, employment opportunities and local programming for families across the country. In addition, six AIDE Network locations across Canada will provide a point of access for Canadians to obtain resources and supports on ASD.
2) The ASD Strategic Fund is providing $9.1 million over 5 years for community-based projects that pursue innovative program models, help reduce stigma, and integrate health, social and educational components to better serve the complex needs of families. One example is the Caregiver Skills Training (CST) project from McGill University that will provide evidence-based skills training for caregivers of children with ASD offering strategies and solutions that can address practical needs and challenges.

Research and Surveillance

The Government of Canada, through the Canadian Institutes of Health Research, invested close to $48 million in research related to ASD between 2014-15 and 2018-19. In the past two years, there has been an investment of close to $23 million in research to increase the understanding of ASD as well as the capacity to treat it effectively. For example, a CIHR-funded research team led by Dr. Lonnie Zwaigenbaum from the University of Alberta developed a tool for detecting ASD at a very early age, which has enabled families to access critical resources and services early, positively impacting their children’s development.

CIHR-funded researchers are also developing innovative technologies for children with ASD and their families. For instance, an interdisciplinary team led by Dr. Francois Bolduc from the University of Alberta is creating an artificial intelligence-based interactive ‘chatbot’ that will allow persons with ASD (and other neurodevelopmental disorders), their families, health professionals and teachers to better navigate the healthcare system by identifying personalized interventions and resources.

Through Canada’s Strategy for Patient-Oriented Research, CIHR and its partners are investing in CHILD-BRIGHT, an innovative pan-Canadian network that aims to improve life outcomes for children with brain-based developmental disabilities and their families. The network’s many projects include:

• “Ready 2 Work”, an online vocational/employment readiness platform developed alongside self-advocates with autism spectrum disorder (ASD), their families, and professionals who operate vocational programs for young people with ASD.
• “MEGA TEAM”, which is evaluating whether a take-home video game can improve executive functioning in children with ASD.

On March 29, 2018, PHAC published the first National Autism Spectrum Disorder Surveillance System report. This federal, provincial and territorial partnership addresses a critical knowledge gap, which will support governments, professionals, health care providers, service providers, educators, communities and stakeholders in meeting the needs of those with ASD. The report provides, for the first time, national data on the number (i.e., prevalence) of children and youth ages 5-17 years living with ASD, based on data collected in 2015 from six provinces and one territory. Key findings highlight that 1 in 66 children and youth have been diagnosed with ASD in Canada.

PHAC has provided $102,189 in the form of a contribution agreement to the Canadian Paediatric Society, to develop ASD Guidelines for early detection and screening, diagnosis as well as post-diagnosis follow-up. The guidelines were released publicly and to health care professionals in October 2019.

Employment and Social Development Canada (ESDC)

The December 2019 Mandate Letter included a commitment toward the creation of a national autism strategy by the Minister of Health with support from the Minister of Employment, Workforce Development and Disability Inclusion.

Employment Support (through the Opportunities Fund for Persons with Disabilities Program) To improve employment outcomes for persons with intellectual disabilities and ASD, Budget 2019 proposes to provide $12 million over three years, starting in 2019–20, to the Canadian Association for Community Living, in partnership with the Canadian Autism Spectrum Disorders Alliance for the Ready, Willing and Able (RWA) program. RWA is a national employment program for persons with intellectual disabilities and ASD.

ESDC Accessible Canada Act (An Act to Ensure a Barrier-Free Canada)

Under the leadership of the Minister of Accessibility, the Government of Canada passed legislation that will transform how the Government of Canada addresses accessibility. The goal of this legislation is to increase the inclusion and participation of all people in Canada, including people with disabilities, and promote equality of opportunity by increasing accessibility and proactively identifying, removing and preventing barriers in areas of federal jurisdiction. The Act received Royal Assent on June 21, 2019.

The Government of Canada supports initiatives that are intended to improve the participation and inclusion of persons with disabilities in all aspects of Canadian society through the Disability component of the Social Development Partnerships Program (SDPP-D). The SDPP-D is a grant and contribution program that provides funding to not-for-profit organizations to address the social issues and barriers facing persons with disabilities. Since 1998, Autism Society Canada has received operating funding through SDPP-D. In April 2019, the Minister of Public Services and Procurement and Accessibility announced operating funding of $18 million over three years (starting in 2019-20) for 28 national not-for-profit disability organizations through the SDPP-D. Under this announcement, Autism Society Canada will receive operating funding of $350,000 over three years. Other organizations supporting individuals with ASD, such as Autism Speaks Canada ($500,000) and the Canadian Autism Spectrum Disorders Alliance ($328,768) will also receive core funding under the program.

National Housing Strategy (NHS)

Under the NHS, the $13.2 billion National Housing Co-Investment Fund provides low-cost loans and contributions for new construction and retrofit of affordable housing. The Co-Investment Fund is targeted to create at least 2,400 new affordable housing units for persons with developmental disabilities. Low-income people living with disabilities will also benefit from funding initiatives for community housing, federal housing investments in provincial and territorial programs, and the upcoming Canada Housing Benefit.

Provincial Funding for ASD

All provinces provide ASD-specific funding for a range of services and supports with current investments focused on interventions, services and education supports for pre-school and school-aged children. While the three territories do not have any ASD-specific funding, they do have supports for broader disability services, which includes ASD.

PHAC Contact: Sally Scott (613) 960-0376, Martha Vaughan (613) 960-0415 and Karen McKinnon (613) 957-7792
PHAC Approved by: Anna Romano, VP-HPCDP (613) 960-2863
CIHR Contact: David Marchand (613) 948-5802

Concussion

Synopsis

Sports and recreational activities have many social and health benefits and are an important part of the lives of children and youth in Canada. Concussions are more common in some sports and recreational activities than others. Efforts are underway to prevent, recognise and manage the public health issue of concussion in Canada.

Key messages

• Our Government recognizes that too many children and youth experience concussion during sports and recreation activities, sometimes with tragic outcomes.
• Through the Canadian Institutes of Health Research, our Government invested close to $34 million in research and initiatives to improve the prevention, diagnosis and treatment of traumatic brain injuries, including concussions.
• Our Government has also provided $2 million to Parachute, a national injury prevention organization, to develop the first Canadian Guideline on Concussion in Sport, return-to-school and return-to-sport concussion protocols, and online training for health professionals.

If Pressed on the Mandate letter

• I look forward to working with the Minister of Canadian Heritage to implement a pan-Canadian Concussion Strategy and raise awareness for parents, coaches and athletes on concussion treatment.

Background

Concussion is a recognised public health issue, which can result in short and long-term effects on brain health. An estimated 46,000 children and youth (aged 5-19 years) were diagnosed with a concussion by hospital emergency departments in 2016-17. Ice hockey, rugby and ringette are the sports with the highest proportion of traumatic brain injuries, including concussion, ranging from 27% to 44% of injuries in children and youth aged 5-19 years, reported by select hospital emergency departments in 2016-17.

Public Health Agency of Canada

The Minister of Health has been mandated to work with the Minister of Canadian Heritage to implement a pan-Canadian concussion strategy and raise awareness for parents, coaches and athletes on concussion treatment.

Budget 2016 committed $1.4 million to support the development and implementation of a harmonized approach with provinces and territories to concussion prevention, detection and management in Canada. With PHAC funding, Parachute created the Canadian Guideline on Concussion in Sport (2017) to present a harmonized approach to concussion management, as well as online concussion medical training and return-to-school and return-to-sport protocols (2018). PHAC also funded the SCHOOLFirst project to provide information to Canadian teachers and school boards on best practices for students returning to school after a concussion, and a new mobile app to help parents manage their child's concussion.

In November 2018, PHAC provided Parachute, a national injury prevention organization, with $1.18 million in funding to produce education and awareness resources for parents and school and sport stakeholders to support Canadians in their return to school, sport and daily activities post-concussion, as well as resources for medical and allied health professionals.

On May 23, 2019, PHAC released the “Understanding and Awareness of Sport-Related Concussions, With a Focus on Youth” public opinion research. The results suggest that the pan-Canadian concussion guideline is beginning to prove effective in comparison to baseline research commissioned by PHAC in 2017-2018.

Canadian Institutes of Health Research (CIHR)

CIHR investments of $34 million (2014-2019), including $7.6 million in 2018/19, supported research on traumatic brain injuries, including concussions. For example, $3.7 million was awarded to Dr. Keith Yeates at the University of Calgary to improve prevention, diagnosis and treatment options. Investments in 2020 will include $1.5 million to establish and guide a national concussion research agenda and improve coordination among key players from research, prevention and treatment.

Canadian Heritage

As part of $30 million provided to Sport Canada in Budget 2019 to ensure a safe and healthy sport system, $800,000 annually for five years will be provided to national sport organizations to address concussion through prevention.

Federal/Provincial/Territorial (FPT) Considerations

The Government of Canada works with FPT Ministers responsible forsport, physical activity and recreation (SPAR) on harmonizing approaches for concussion prevention and management in sport. In February 2019, SPAR Ministers re-affirmed that concussions are a major public health concern and committed to take additional action to increase awareness, prevention, detection, management, and surveillance of concussions. Jurisdictions agreed to work to implement an annual concussion awareness day, in collaboration with the sport sector.

Ontario is the only province that has concussion specific legislation in force. Rowan’s Law, 2018, requires sport organizations to have concussion protocols in place and proclaims Rowan’s Law Day to be observed annually on the last Wednesday in September. The law also amends the Ontario Education Act to authorize the Minister to establish and require boards to comply with policies and guidelines on student concussions.

Parliamentary Business

• During the previous Parliament, the House of Commons Standing Committee on Health (HESA) established a Subcommittee to undertake a study on sport-related concussions. In June 2019, HESA tabled the Subcommittee’s report entitled “Tackling the Problem Head-on: Sports-Related Concussions in Canada”.

PHAC Contact: Barrett Halliday, A/ Executive Director (613) 793-7723
PHAC Approved by: Anna Romano, VP-HPCDP (613) 960-2863
CIHR Contact: Hana Kokanovic, Senior Policy Advisor 343-550-2944;

Coronavirus - COVID-19

Synopsis

Canada has been monitoring an outbreak of COVID-19 that originated in Wuhan, China and was associated with a live seafood/animal market. While the majority of cases have been reported in Wuhan, Hubei Province, cases are being reported in other provinces within mainland China and internationally in 107 countries and jurisdictions and international conveyances.

Key messages

• The health and safety of all Canadians is our top priority – both here in Canada as well as in affected areas abroad.
• As of today, seventy-six (76) publicly announced cases of COVID-19 have been confirmed in Canada.
• On Monday, health officials in British Columbia confirmed Canada’s first death in connection with coronavirus.
• A plane chartered by the Canadian government to repatriate it’s citizens from a cruise ship previously held off the coast of California has landed at the Canadian Forces Base (CFB) in Trenton, Ontario at 6:30 a.m. today and passengers have arrived in Trenton.
• The Public Health Agency of Canada (PHAC) is recommending that Canadians avoid all cruise ship travel due to the ongoing COVID-19 outbreak. Canadians who choose to voyage on a cruise ship should also be aware that they may not be offered the opportunity to return to Canada on a government-organized repatriation flight, or could be responsible for the costs of repatriation travel.
• Our efforts continue to focus on preparing our health system, our communities and our families for the sustained spread of the virus in Canada.
• We continue to regularly engage our international, provincial and territorial partners to monitor the situation and to share information on responses to the outbreak.

If pressed on Grand Princess Cruise Ship – California

• Ensuring the safety and security of the 237 Canadians on board the cruise ship, and those in Canada—is our top priority.
• We have taken action to return Canadians home from the cruise ship, currently docked at the port of Oakland.
• Each returning Canadian will be screened for symptoms before boarding the plane and will continue to be assessed for symptoms of COVID-19 throughout their 14-day stay at CFB Trenton. Should someone develop symptoms and test positive for COVID-19, they would be transferred immediately to hospital for treatment.

If pressed on Canada’s response to Pandemic preparedness

• We continue to plan for all possible scenarios and base our responses on evidence as the science of COVID-19 continues to emerge.
• This is a rapidly evolving situation and we are seeing an increase in the numbers of positive cases reported both internationally as well as here in Canada.
• Public health authorities across Canada are working together to ensure that our preparedness and response measures are appropriate and adaptable, based on the latest science and the evolving situation.
• Should the need arise, we have robust federal, provincial and territorial pandemic preparedness plans, as well as emergency response plans in place to respond to a pandemic situation.

If pressed on the New Cabinet Committee – COVID-19

• On March 4, a Cabinet Committee on the federal response to the COVID-19 was established.
• The committee is meeting regularly to ensure whole-of-government leadership, coordination, and preparedness for a response to the health and economic impacts of the virus. This includes coordination of efforts with other orders of government.

If pressed on Canadians in affected areas abroad

• Our Government takes the safety and security of Canadians abroad very seriously and we continue monitoring the situation closely.
• Canadians should consult our Travel Advice and Advisories for up-to-date information on the situation.
• We stand ready to provide consular assistance to Canadian citizens as required.
• Canadians in need of assistance should contact their nearest consular office.

If pressed on Passengers who have tested positive on the Cruise ship in Japan

• As of March 10 2020, Fifty-six (56) Canadian passengers of the Diamond Princess tested positive for COVID-19. Of those, twenty- five (25) are hospitalized with three (3) in critical condition, and the remainder are in stable condition. Thirty-one (31) Canadians have been released from the hospital after two negative test results.
• Those who remain in Japan will continue to receive full consular services from the Government of Canada.

If pressed on Border Measures

• Canada has a number of standard border measures in place to mitigate the potential risk of introduction and spread of communicable diseases into Canada. We also have a number of enhanced border measures in place in response to the current outbreak of COVID-19.
• We have general messaging in ten key airports as well as a general handout for all international travellers advising them to self-monitor and to call local public health authorities if they develop symptoms of COVID-19.
• Anyone who is sick is asked to self-identify to Border Services Agent.
• Travellers entering Canada from land, rail and ferry points of entry will be subject to the same enhanced border measures as travellers entering Canada by air, including screening to identify travellers from Hubei province, China or Iran. These travellers are referred for additional health screening questions.
• We provide advice for all travellers, through regularly updated Travel Health Notices based on the evolving situation with COVID-19.

Cruise ships

• We are recommending that Canadians avoid all cruise ship travel due to the ongoing COVID-19 outbreak. Cruise passengers include travellers from around the world who may be arriving from areas with known or unknown spread of the novel coronavirus that causes COVID-19.
• Cruise ships present a unique environment where COVID-19 can easily spread, given the extent and frequency of interaction amongst cruise passengers and the close quarters found on most vessels.
• Recent cruise ship outbreaks of COVID-19, indicate that a large proportion of individuals onboard can become infected. While the majority of affected passengers may experience mild symptoms, there have been a significant number of cases requiring hospitalization and critical care, and some deaths have been reported.
• As the situation evolves, many countries are implementing policies and restrictions in order to contain the outbreak, which could ultimately result in travellers being subject to quarantine procedures.

If pressed on Northern Healthcare

• Indigenous Services Canada is working with the Public Health Agency of Canada, other relevant departments, and its provincial and territorial counterparts to protect the health and safety of First Nations, Metis and Inuit and support them in responding to public health threats, including COVID-19.

Background

Coronaviruses

Coronaviruses are a group of viruses that can cause a wide range of respiratory symptoms (‘common cold’ type symptoms to bronchitis or pneumonia) in humans. Two specific coronaviruses which have previously been associated with outbreaks of severe respiratory disease, SARS and MERS, were ruled out as the cause of the Wuhan cluster.

Current Situation

We are working collectively with the global community under the leadership of the World Health Organization and are in constant communication with our provincial and territorial counterparts.
Public health authorities across Canada at all levels of government are working together to adapt our response to this rapidly changing situation. We are reviewing existing resources and systems to ensure we are prepared to address all scenarios and base our response measures on evidence as the science of the novel coronavirus continues to emerge.

While the large majority of cases are in mainland China, this virus has now been detected in an increasing number of countries around the world, including community spread in some of these countries. It is prudent that we prepare for the possibility that the virus could spread further. However, we need to plan for all possible scenarios.

Travellers returning to Canada from areas affected by the COVID-19 outbreak should be attentive to messages and instructions being provided at Canadian airports. They will be asked about their travel history and may be asked further questions about their health.

As of today, seventy-six (76) cases of COVID-19 have been confirmed in Canada.
On Monday, the province of British Columbia announced the death of a former resident of a long-term care facility in the province. This is Canada’s first death in connection with coronavirus.
Contact tracing and public health management for all cases are being undertaken by relevant provincial and local public health officials.
The Grand Princess Cruise Ship was quarantined off the cost of California due to a possible COVID-19 Outbreak. Following a request for assistance from the United States, the Government of Canada has decided to have Canadian passengers from the Grand Princess transported to Canada to complete their 14-day quarantine. Canadian citizens will not have the option of completing their quarantine on the ship or at a facility in the United States.

A chartered flight will bring passengers cleared for travel from Oakland to Canadian Forces Base Trenton.

Quarantine sites have been established in BC and Alberta for Princess Diamond passengers who did not return on the Government of Canada repatriation flight and present themselves at a port of entry.

Identification of additional cases of COVID-19 in Canada is expected due to the volume of international travel.

There have also been weekly communications with provincial and territorial public health partners via the Council of Chief Medical Officers of Health, the Canadian Network for Public Health Intelligence, the Canadian Public Health Laboratory Network, relevant federal partners, and other relevant networks to share currently available information and identify appropriate resources for, among other things, infection prevention and control as well as public health management.

In addition, the Public Health Agency of Canada, through Canada’s Chief Public Health Officer, is also in close contact with provincial and territorial Chief Medical Officers of Health to share information, coordinate response efforts, and support informed vigilance as the situation evolves both domestically and internationally.

Since the outbreak of COVID-19, the Government of Canada has been working with provinces, territories, and international partners to protect the health and well-being of Canadians. As more countries begin to deal with COVID-19 outbreaks, the Government of Canada is investing in Canadian researchers to learn more about this novel coronavirus and to develop tools and resources to combat it. 

Current Case Counts

China

As of today, Mainland China has reported 80,754 of COVID-19 across all provinces cases with 3,136 deaths.

71% of all cases identified globally have been in mainland China. China continues to introduce and enforce exceptional measures intended to limit further transmission of the virus.

International

As of today, 33,637 cases of COVID-19, 887 reported deaths, have been confirmed in 107 countries/jurisdictions outside of Mainland China and aboard one international conveyance.

Four new countries/jurisdictions reported cases of COVID-19 in the past 24 hours: Brunei, Cyprus, Mongolia, Panama.

South Korea reported 7,513, Italy 9,172, Iran 7,161, Japan 514 and France 1,412 confirmed cases of COVID-19.

As of March 9, Italy has extended its emergency coronavirus measures, which include travel restrictions and a ban on public gatherings, to the entire country.

Public Health Activities in Canada

PHAC continues ongoing monitoring, intelligence gathering and international engagement to inform Canadian public health action. Canada also continues to collaborate with federal, provincial, and territorial partners to share information and ensure Canadian readiness to respond should a case present in Canada. Specific activities include:

• Activation of the Health Portfolio Operations Centre (HPOC) to Level 3, Partial Escalation, which supports effective planning and coordination of preparedness activities across the Agency;
• Development and implementation of new diagnostic tests by PHAC’s National Microbiology Laboratory (NML) to identify the COVID-19;
• Issuance of Travel Health Notice (THN) to provide the latest information and recommendations for individuals travelling to, and returning from, China;
• Development of infection prevention and control (IPC) and public health guidance to support front-line workers;
• Development of a national case definition to aid with surveillance efforts and consistent reporting;
• Distribution of a general Occupational Health Advisory to departments and agencies with information about COVID-19 and working with Global Affairs Canada to ensure that federal employees in affected countries have all the occupational health information they require; and,
• Communicating weekly with provincial/territorial public health partners via the Council of Chief Medical Officers of Health (CCMOH), the Canadian Network for Public Health Intelligence (CNPHI), the Canadian Public Health Laboratory Network (CPHLN), relevant federal partners, and other relevant networks to share currently available information and identify appropriate resources for investigation and reporting of cases of COVID-19 as well as for infection prevention and control and public health management.

Domestic Surveillance

The Canada Border Services Agency (CBSA) is engaged, and standard traveller screening procedures are in place to prevent the introduction and spread of communicable diseases into Canada.

Existing screening procedures have been augmented to include messaging on arrivals screens at airports reminding travellers to inform a border service officer if they are experiencing flu-like symptoms. An additional screening question has been added to electronic kiosks and travellers are receiving handouts.

International Surveillance

China has implemented exceptional measures to reduce further spread of the virus, including transportation shutdowns, exit screening, strict infection prevention and control measures, closure of public and commercial spaces and limiting or canceling of large public gatherings.
Several countries and autonomous regions (e.g., Iran, Italy, South Korea, Cambodia, Indonesia, India, Japan, Malaysia, Philippines, and Thailand) have increased public health vigilance, with temperature screening at ports of entry and/or statutory reporting of pneumonia of unknown cause for cases of acute respiratory illness.

Research

Since the outbreak of COVID-19, the Government of Canada has been working with provinces, territories, and international partners to protect the health and well-being of Canadians. As more countries begin to deal with COVID-19 outbreaks, the Government of Canada is investing in Canadian researchers to learn more about this novel coronavirus and to develop tools and resources to combat it.   

To further contribute to global efforts to address the COVID-19 outbreak, the Honourable Patty Hajdu, Canada’s Minister of Health, and the Honourable Navdeep Bains, Canada’s Minister of Innovation, Science and Industry, announced an investment of nearly $27 million to fund coronavirus research. Due to the overwhelming response to the call for research applications, the Government of Canada increased its original investment from $7 million to $27 million. This investment will support 47 research teams from across Canada that will focus on accelerating the development, testing, and implementation of measures to deal with the COVID-19 outbreak. The Ministers made the announcement with the Honourable Mélanie Joly, Minister of Economic Development and Official Languages, and the Honourable Yves Duclos, President of the Treasury Board.

The research will help inform clinical and public health responses, develop and evaluate diagnostic tools and vaccines, as well as create strategies to tackle misinformation, stigma, and fear. The Government of Canada is providing the funding for this research through the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council of Canada (NSERC), the Social Sciences and Humanities Research Council (SSHRC), the Canada Research Coordinating Committee (CRCC) through the New Frontiers in Research Fund (NFRF), the International Development Research Centre (IDRC), and Genome Canada (GC).

Contact: Cheryl Scott / HPOC Planning
Approved by: Cindy Evans, Event Manager

Dementia

Synopsis

In June 2019, A Dementia Strategy for Canada: Together We Aspire was released. Federal investments in dementia research, surveillance, awareness initiatives, community-based projects, and guidance on diagnosis and treatment will support the implementation of the strategy. As per the 2017 National Strategy on Alzheimer’s Disease and Other Dementias Act, the Government of Canada will report annually to Parliament in June on the implementation of the national dementia strategy.

Key messages

• In June 2019, our government released Canada’s first national dementia strategy. Our vision is bold: preventing dementia; effectively treating it; and supporting all people living with dementia and their caregivers by improving their quality of life.
• In 2019, our government announced over $81 million over 5 years to support the strategy with funding for dementia awareness initiatives, surveillance efforts, guidance on diagnosis and treatment, and research.
• This is in addition to over $200 million invested in the last five years to advance research on dementia prevention, diagnosis, treatment and care, and to support community-based projects.

Background

Dementia describes a variety of neurological conditions characterized by gradual loss of cognitive functions that affects daily activities. Alzheimer’s disease is the most common form. There is no known cure and the causes are not precisely known. In 2016-17, over 432,000 Canadians aged 65 plus were living with some form of diagnosed dementia. This number is expected to increase with Canada’s growing and aging population.

The Public Health Agency of Canada (PHAC)
A Dementia Strategy for Canada: Together We Aspire was released in June 2019 along with the first annual report to Parliament. The strategy identifies three national objectives: prevent dementia; advance therapies and find a cure; and improve the quality of life of people living with dementia and their caregivers.

Budget 2019 announced $50 million over 5 years for initiatives to support the strategy’s implementation. Federal investments will focus on dementia surveillance, awareness, community-based projects, and guidelines on diagnosis and treatment. Treatment and care fall primarily within the jurisdiction of provinces and territories. The first open solicitation for funding awareness initiatives was launched January 10, 2020.

Budget 2018 allocated $20 million over 5 years ($4 million per year ongoing) to establish the Dementia Community Investment (DCI), which funds community-based projects that aim to optimize the wellbeing of people living with dementia and family/friend caregivers by developing, testing, disseminating and scaling up initiatives, knowledge and tools to support these groups. The DCI has launched seven projects to date and additional projects will be launched in winter 2020. A Knowledge Hub will also be funded to facilitate information sharing between projects and share results with the broader dementia community.

As part of its core public health surveillance functions, PHAC works with all provinces and territories through the Canadian Chronic Disease Surveillance System to collect data on Canadians living and newly diagnosed with dementia. Data is updated annually to provide a picture of the prevalence, incidence and all-cause mortality related with dementia by age group, sex, province and territory and over time.

The Canadian Institutes of Health Research invested approximately $80 million in the last 2 years on dementia research and innovation and over $200 million over the past 5 years (2014-2015 to 2018-2019) in dementia related research, including through the CIHR Dementia Research Strategy (DRS), which supports research on prevention, delaying onset of symptoms, and improving quality of life. The Strategy is comprised of the Canadian Consortium on Neurodegeneration in Aging (CCNA) and an international component, which facilitates Canadian participation in key international research partnerships, such as the EU Joint Programme on Neurodegenerative Disease Research. In June 2019, the renewal of the CCNA was announced with federal funding of $31.6 million and an additional $14 million from partners over the next five years to support the second phase of the initiative.

The Centre for Aging and Brain Health Innovation (CABHI) was established with a federal contribution of $42 million over five years (2015-20) to Baycrest Health Sciences. CABHI accelerates the development, validation, commercialization, dissemination and adoption of innovative products, services and best practices to support brain health and aging, including dementia. Canada has endorsed the Global Action Plan on a Public Health Response to Dementia (2017-2025). The WHO’s Global Dementia Observatory (2017), supported by the Government of Canada is actively collecting data. PHAC represents Canada on the World Dementia Council.

PHAC Contact: Franca Gatto (613) 948-9187
PHAC Approved by: Anna Romano, VP-HPCDP (613) 960-2863
CIHR Contact: David Marchand (613) 948-5802

Diabetes

Synopsis

Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Diabetes can lead to serious complications and premature death. Those who have diabetes can take steps to control the disease and lower the risk of complications.

Key messages

• The Government recognizes the impact diabetes has on the health of Canadians. Approximately 3 million Canadians are living with diabetes and 200,000 new cases are diagnosed each year.
• We are making investments in research, prevention, and early detection of diabetes; so that fewer Canadians develop this condition and that better treatments are available when diabetes occurs.
• Over the last five years, we invested approximately $229 million towards diabetes research with over $48 million funded in 2018-2019 alone.
• CIHR recently launched an initiative to celebrate 100 Years of Insulin: Accelerating Canadian Discoveries to Defeat Diabetes. To date, it represents a total commitment of approximately $47 million over 7 years ($29 million from CIHR; $18 million from a range of provincial, national and international partners).
• In partnership with organizations from the private and non-profit sectors and other levels of government, we are testing and scaling up interventions in communities across the country to prevent diabetes. These interventions focus on common risk factors for chronic diseases, including diabetes, such as unhealthy eating and physical inactivity.

Background

In 2021, Canada will celebrate the 100th anniversary of the discovery of insulin, a discovery that changed the lives of millions of people in Canada and around the world, and won Canadian researchers F.G. Banting and J.J.R. Macleod the Nobel Prize in Physiology or Medicine. The discovery of insulin is arguably one of the most important in the history of medicine and one of the most dramatic examples of rapid translation of a discovery in basic science into a benefit for patients.

Public Health Agency of Canada (PHAC) undertakes data collection and analysis of chronic diseases and their risk and protective factors; strengthens collaborations to better track disease trends and risks; supports the development of prevention guidelines for primary care; and shares knowledge of best practices and effective interventions. PHAC also leads the Pan-Canadian Health Inequalities Reporting Initiative, which monitors over 100 indicators of health outcomes and determinants, including several related to diabetes, disaggregated across a range of population groups at the national, provincial, and territorial levels.

PHAC’s Healthy Living and Chronic Disease Prevention - Multi-sectoral Partnerships (MSP) program invests $20 million annually and has leveraged additional non-governmental funding of more than $100 million since its inception to promote healthy living and prevent chronic disease, and to address the common risk factors (e.g. physical inactivity, unhealthy eating, and tobacco use) that underlie major chronic diseases, including diabetes. Example investments include:

• Canadian Diabetes Prevention Program – In partnership with Diabetes Canada, LMC Prevention Ltd. is implementing a 12-month lifestyle intervention program to reduce the risk of type 2 diabetes in Canada by supporting behaviour changes and weight loss. The program targets individuals at risk of developing diabetes and those diagnosed with prediabetes.
• Hockey Fans in Training (Hockey FIT) – Western University is implementing a project to increase physical activity and healthy eating behaviours among middle-aged overweight and obese men at risk of chronic disease, including diabetes. The program targets men from urban and rural communities, Indigenous communities, different cultures (e.g., new Canadian immigrant communities), and individuals across the socioeconomic spectrum.

To help Canadians understand their risk factors and motivate them to make lifestyle changes to prevent diabetes, PHAC developed CANRISK, a diabetes risk questionnaire that provides an individual risk score as well as guidance on risk reduction. CANRISK is accessible to Canadians through partnerships with Diabetes Canada, as well as with Shoppers Drug Mart, Pharmasave, Rexall, Loblaws and others.

Canadian Institutes of Health Research (CIHR)

From 2014-2015 to 2018-2019, the Canadian Institutes of Health Research (CIHR) invested approximately $229 million towards diabetes research with over $48 million funded in 2018-2019 alone. CIHR also funds research in areas such as obesity, kidney disease and cardiovascular disease that impact on diabetes prevention and management of the complications of diabetes. Key strategic diabetes-related research activities are included in the Pathways to Health Equity for Aboriginal Peoples Initiative, Canada’s Strategy for Patient-Oriented Research, and a new Partnership to Defeat Diabetes with the Juvenile Diabetes Research Foundation. In 2018, CIHR hosted diabetes researchers and experts to identify research gaps and priorities to inform new research investments.

Parliament

The Standing Committee on Health released its report on its study of Diabetes Strategies at Home and Aboard on April 10, 2019. It had 11 recommendations in seven thematic areas. These are: (1) a national diabetes strategy for Canada, (2) research funding, (3) disability tax credit, (4) provincial/territorial coverage of diabetes-related medications, supplies and equipment (5) cost of insulin, (6) access to health services including in rural and remote communities, and (7) diabetes-related education and training for health care professionals. The government response was prepared, but not tabled due to the 2019 Federal Election.

In June 2019, the House of Commons passed a motion (M-173) designating the month of November as Diabetes Awareness Month.

Budget 2019/20

Diabetes Canada has publicly expressed disappointment not to have received funding in Budget 2019 for their national strategy to address diabetes as outlined in their Diabetes 360◦ report, and is continuing to call for $150 million over seven years in Budget 2020.

Contact: Barrett Halliday, 613-946-6965
Approved by: Anna Romano, Vice President, 613-960-2863

Family and gender-based violence

Synopsis

Family violence accounts for 26% of violent crime reported to police. Women are at greater risk of family violence than men, with women and girls representing 68% of victims in police-reported family violence. One third of Canadian adults have reported experiencing abuse before age 15.

Key messages

• Gender-based violence, including family violence, is a serious public health issue that can have lasting impacts on both physical and mental health of Canadians.
• Our Government has invested nearly $200 million over the last five years to establish the Strategy to Prevent and Address Gender-Based Violence.
• This includes investments in preventing teen dating violence and child maltreatment, and equipping health professionals to provide appropriate care to survivors.
• We are also investing approximately $6 million annually in community-based projects that support the health of survivors of family violence.

Background

The consequences of family violence and gender-based violence can include short and long-term mental and physical health effects as well as social and economic costs. These can include: behavioural problems in children; drug and alcohol use and attempted suicide in teens; chronic diseases, pain and lack of stable employment in adulthood; and, depression and financial problems in older adults. In addition, spousal violence alone costs Canadian society $7.4B annually.

Public Health Agency of Canada Initiatives
From Budget 2017, the PHAC is investing:

• $3.5 million over 5 years and $700,000 per year ongoing to deliver and test programs to prevent teen/youth dating violence; and
• $6 million over 5 years and $1.3 million per year ongoing to deliver and test parenting programs to prevent child maltreatment.

From Budget 2018,PHAC is investing:

• An additional $26.7 million over five years and $6.2 million per year ongoing to prevent

teen/youth dating violence from the Gender-Based Violence Prevention Fund under Health Promotion; and

• $4.5 million over five years and $1 million per year ongoing to support the development of training curricula and resources about gender-based violence, trauma-informed care and safety planning for health and allied professionals.

There are currently 31 projects funded as part of the Preventing Gender-Based Violence: The Health Perspective program.

• 24 of these projects are promoting healthy relationships and preventing dating violence among teens/youth;
• two are focused on preventing child maltreatment through parenting support programs; and,
• five projects are equipping providers to recognize and respond safely to gender-based violence.

Other Government Initiatives

Supporting the Health of Survivors of Family Violence
In addition to these new investments to prevent gender-based violence, PHAC invests over
$6 million per year to support the health of survivors of family violence, through guidance and training for professionals, and through the delivery and testing of health promotion interventions for survivors. These projects are measuring their impact on health outcomes such as anxiety, depression and Post-Traumatic Stress Disorder.

Preventing Gender-Based Violence

It’s Time: Canada’s Strategy to Prevent and Address Gender-Based Violence, launched in 2017, has received nearly $200 million over five years in new investments and over $40 million per year ongoing to advance efforts in three pillar areas: prevention; support for survivors and their families; and promotion of responsive legal and justice systems. This Strategy includes investments by the Department for Women and Gender Equality, Public Health Agency of Canada (PHAC), Public Safety Canada, the Department of National Defence, the RCMP, and Immigration, Refugees and Citizenship Canada.

Family Violence Initiative

PHAC is a member of the federal Family Violence Initiative (FVI), which brings together 15 departments and agencies in a multi-sectoral approach to addressing family violence. On behalf of the FVI, PHAC hosts and coordinates Stop Family Violence, a web-based source of current information on family violence for health professionals and the public. Stop Family Violence also provides links to supports and services available in each province and territory.

Other

The Health Portfolio also supports maternal-child health programs that strengthen family relationships and reduce risk factors for violence; conducts surveillance on family violence; and supports analysis to understand the nature and impacts of family violence.

PHAC Contact: Karen McKinnon (613) 957-7792
PHAC Approved by: Anna Romano, VP-HPCDP (613) 960-2863

HIV/AIDS

Synopsis

The Government of Canada has endorsed global targets that aim to end the AIDS and viral hepatitis epidemics and reduce the health impacts of sexually transmitted infections by 2030. Community-based organizations and researchers have called on the Government of Canada to increase funding to address HIV and other sexually transmitted and blood-borne infections (STBBI) in Canada.

Key messages

• Our Government is taking action, with our partners, to prevent HIV, viral hepatitis, and sexually transmitted infections.
• We are investing more than $88.5 million this year in research, prevention, diagnostic technology and support for communities.
• Canada’s community-based organizations are at the front-line in preventing infections and supporting treatment and care. We are supporting their work.
• We will continue to provide leadership in Canada and globally.

Background

The Pan-Canadian Sexually Transmitted Blood-Borne Infections Framework for Action
In 2018, federal, provincial and territorial ministers of health released the Pan-Canadian Sexually Transmitted Blood-Borne Infections (STBBI) Framework for Action to guide Canada’s efforts to reduce the health impacts of these infections and contribute to global efforts.

Government of Canada Five-Year Action Plan on STBBI
In July 2019, the Government of Canada released its five year Action Plan on STBBI (2019-2024) which outlines a renewed and expanded collaborative approach to implementing the STBBI Framework for Action within the federal mandate. The Action Plan encompasses the work of ten federal departments, reflecting a whole-of-government approach. The Action Plan aims to accelerate Canada’s efforts to prevent, diagnose and treat STBBI, and address barriers to care. The Action Plan is based on the latest evidence and reflects priorities identified by partners and stakeholders.

• The Action Plan outlines seven priority areas for federal government action on STBBI:
  • Moving toward truth and reconciliation with First Nations, Inuit, and Métis peoples
  • Reducing stigma and discrimination
  • Community innovation
  • Reaching the undiagnosed
  • Providing prevention, treatment and care to populations that receive health services or coverage of health care benefits from the federal government
  • Leveraging existing knowledge and targeting future research
  • Measuring impact - monitoring and reporting on trends and results

Investments in community-based projects are a key component of the Government’s response and the Government works closely with its provincial and territorial (P/T) counterparts to ensure efforts complement and strengthen the impact of their investments. The $88.5 million in funding this year includes: surveillance; guidance for health professionals; research; support for the community-based response; and, support to First Nations Inuit, and Métis communities. As part of this investment, $26.4 million annually is to support communities through the HIV and Hepatitis C Community Action Fund and $7 million annually, is to support communities through the Harm Reduction Fund.

HIV and Hepatitis C Community Action Fund

Through the HIV and Hepatitis C Community Action Fund (CAF), launched in 2017, the Government of Canada is investing $26.4 million annually to support 85 projects working at the community level to prevent new infections, reduce stigma and discrimination and increase access to testing and treatment. From this investment, $4 million annually is dedicated to projects led by Indigenous organizations.

Priorities for this funding program focus on slowing the spread of STBBI, decreasing the number of people who are unaware of their infections, increasing the number of people accessing treatment, and addressing the effects of stigma. CAF supports integrated approaches to disease prevention, increasing the effectiveness of prevention initiatives and supporting a more efficient community-based response by addressing common transmission routes, risk behaviours, affected populations, and stigma associated with STBBI.

Harm Reduction Fund
Through the Harm Reduction Fund (HRF), the Government of Canada invests $7 million annually to support community-based projects across Canada that will help reduce HIV and hepatitis C among people who share drug-use equipment such as needles and pipes. These funds complement existing investments under CAF by focusing on a population that is particularly at-risk for these infections. The funding helps community-based organizations implement or enhance harm reduction measures, such as providing: education resources for people who use drugs; support for peer-based outreach and navigation initiatives; and training for health providers.

In addition to research funded through the Five-Year Action Plan on STBBI, the Canadian Institutes of Health Research (CIHR), from 2014-15 to 2018-19, funded over $224 million on HIV/AIDS research and more than $24.6 million on Hepatitis C research through its investigator-initiated research programs.

Additional STBBI specific investments have also recently been made, including:

• More than $48 million over five years for STBBI programs and services for First Nations and Inuit communities (Indigenous Services Canada).
• $5 million over five years under the new Innovative Diagnostics Program at the National Microbiology Laboratory.

PHAC Contact: Geneviève Tremblay (613) 957-1345
PHAC Approved by: Kimberly Elmslie, VP IDPC (613) 954-9663

LGBTQ2 access to health

Synopsis

LGBTQ2 populations in Canada experience inequalities across a range of social and economic conditions that support health. Many of these inequalities are the result of stigma and discrimination, which create barriers to health and social services.

Key messages

• The Government of Canada is committed to promoting LGBTQ2 equality, protecting rights, addressing discrimination against communities, and reducing LGBTQ2 health inequalities.
• Our approach acknowledges the social and economic factors that affect the health of LGBTQ2 Canadians, and aims to reduce stigma and discrimination that can lead to health and social inequalities.
• We are investing in health promotion and disease prevention programs to address the unique needs of LGBTQ2 populations.
• We are working with partners to strengthen data and evidence to better understand and address health inequalities experienced by LGBTQ2 populations in Canada.

Background

Issues and Current Actions:
Evidence on inequalities in health status, health behaviours, and determinants of health for lesbian, gay, and bisexual Canadians is produced through the Pan-Canadian Health Inequalities Reporting Initiative, led by Public Health Agency of Canada (PHAC) in collaboration with the Pan-Canadian Public Health Network, Statistics Canada, the Canadian Institute for Health Information, and the First Nations Information Governance Centre. Products from this initiative include the interactive Pan-Canadian Health Inequalities Data Tool, which contains over 100 indicators of health outcomes and health determinants disaggregated across a range of socio-demographic and economic population groups, including sexual orientation, at the national, provincial, and territorial levels. It provides a systematic portrait of the state of health inequalities in Canada and represents the most comprehensive pan-Canadian data resource on health inequalities currently available.

PHAC has been collaborating with Statistics Canada, Women and Gender Equality (WAGE), and the LGBTQ2 Secretariat at Canadian Heritage to enable coordinated action in identifying and addressing gaps in data, evidence, policy, and practice related to LGBTQ2 health.

The Government of Canada recognizes that LGBTQ2 Canadians face higher risks of family violence, gender-based violence, and mental health disorders. PHAC’s Family Violence Prevention Investment focuses a portion of its funding on preventing and reducing the health impacts of family violence for these populations. Currently, two projects focus specifically on trans, non-binary, and Two-Spirit people.

Suicidal thoughts, plans and attempts are disproportionately prevalent among LGBTQ2 youth compared to non-LGBTQ2 peers. PHAC is supporting the development of a pan-Canadian suicide prevention service that will provide people in Canada with access to bilingual crisis support. Under this service, responders will be equipped with training and resources to deliver crisis support that is trauma-informed, culturally safe and sensitive to LGBTQ2 populations. Additionally, PHAC is investing in programs to prevent dating violence among LGBTQ2 youth, and to equip health and social service professionals to respond safely to gender-based violence in LGBTQ2 populations.

PHAC has also integrated components specifically designed to address needs of LGBTQ2 populations within a number of its community-based Grants and Contribution Programs so that they are informed by an equity-promoting, anti-stigma, and anti-discrimination lens. Data have shown elevated smoking rates among various LGBTQ2 communities in Canada. Canada’s Tobacco Strategy will seek to address these challenges through targeted efforts.

PHAC’s Multi-sectoral Partnerships (MSP) program aims to increase the reach and impact of evidence-based approaches that support healthy choices and behaviours. Recognizing that certain sub-groups of Canadians are at higher risk of developing chronic diseases and experience higher prevalence of risk factors, the MSP program is focusing its efforts on these groups. For example, the University of Toronto has received MSP program funding for a project entitled: “All Together Now! An Intervention to Reach LGBTQI2S+ Young Adult Smokers”. This project will use social media platforms such as Instagram and Twitter to address tobacco use among young adults in the LGBTQ2 population.

PHAC recognizes that gay, bisexual, Two-Spirited, trans and queer men remain disproportionally impacted by HIV and other sexually transmitted and blood-borne infections (STBBI). To help reduce STBBI-related stigma, PHAC has developed tools for health professionals and is prioritizing its investments for community-based interventions. These tools will provide evidence-based information to affected populations and equip health and other service providers to offer services in a safe and non-stigmatizing environment. In January 2019, the Canadian Centre for Gender and Sexual Diversity was awarded a grant by PHAC to run a national HIV anti-stigma campaign that aims to reduce the adverse effects stigma has on HIV prevention, testing, access to treatment among gay, bisexual and two-spirit men as well as trans people.

Health Canada is committed to ensuring the integration of a sex and gender-based perspective in developing and delivering an evidence-informed cannabis public education and awareness campaign. Available research suggests that sexual orientation and gender identity status are linked to increased substance use in general. Health Canada is exploring opportunities to better engage LGBTQ2 community members and organizations in the development of public education messages, advertising campaigns, and outreach efforts. Health Canada is also exploring ways to better leverage funding through the Substance Use and Addictions Program to address the needs of the LGBTQ2 community across a number of substance areas.

Contact: Marie DesMeules (613-952-3285)
Approved by: Anna Romano (613) 960-2863

Lyme disease

Synopsis

Lyme disease continues to draw public, political and media attention with particular scrutiny on the number of human cases, risks, diagnosis and treatment in Canada.

Key messages

• Our Government recognizes that Lyme disease is increasing in Canada, due in part to climate change.
• We are committed to working with stakeholders to help protect Canadians.
• We are raising public awareness of Lyme disease and making sure health care providers have the information they need to recognize the symptoms.
• We also recognize the need for more research on Lyme Disease. That is why the Government is providing $4 million to the Canadian Lyme Disease Research Network that focuses on diagnosis and treatment.

If pressed on lyme disease during pregnancy …

• Our government recognizes that further research is required to better understand if there may be adverse effects of Lyme disease during pregnancy.
• Our government will continue to support research to help address the significant knowledge gaps that exist on this topic.

If pressed on changes to cdc website language …

• PHAC is aware of the recent updates to the United States’ Centers for Disease Control and Prevention website regarding Lyme disease and pregnancy. 
• PHAC will continue to monitor new evidence as it becomes available, and is committed to providing Canadians with up-to-date information on Lyme disease so that they can take measures to protect their health.

Background

Caused by the bite of an infected blacklegged tick, Lyme disease can cause serious symptoms such as long-term neurological problems, chronic pain and fatigue. However, if diagnosed early, it can be effectively treated with antibiotics. The number of regions with established blacklegged ticks continues to increase across Canada. The provinces reported 2,025 cases of Lyme disease in 2017, comparatively to 992 cases in 2016. The incidence of Lyme disease is increasing in many areas of Canada, in part due to climate warming and associated expansion of tick habitat.

Federal Role:
The Public Health Agency of Canada (PHAC) monitors Lyme disease in Canada. It provides national information on the number of cases reported and identifies where Lyme disease is present and emerging in Canada. Addressing Lyme disease is a shared responsibility. In partnership with public health authorities at other levels of government, the Government of Canada is raising awareness through public education; supporting surveillance activities and national reporting; conducting and supporting laboratory diagnostic testing; engaging with international and domestic organizations; and funding research. Provinces and territories provide healthcare services to Lyme disease patients and coordinate prevention and control activities.

Federal Framework on Lyme Disease

The Federal Framework on Lyme Disease Act came into force on May 30, 2017. The effectiveness of the Framework must be reviewed in five years, and a report on these findings must also be tabled in each House of Parliament (2022). The Framework includes an Action Plan with three pillars:

• Surveillance : Coordination of national surveillance to monitor and report on human cases of Lyme disease and the geographic distribution of ticks;
• Education and Awareness: Increasing awareness of Lyme disease among health professionals and the general public; and,
• Guidelines and Best Practices: Supporting medical professionals and provincial laboratories in the diagnosis of Lyme disease and work to improve laboratory diagnostic testing.

There is no dedicated long term funding for the implementation of the Federal Framework on Lyme disease.

Research Network on Lyme disease

Between 2014-15 and 2018-19, CIHR invested approximately $2.6 million in Lyme disease research. This includes approximately $1.1 million in 2018-19.

In October 2018, CIHR and PHAC invested $4million over 4 years in the Canadian Lyme Disease Research Network, led by Dr. Kieran Moore from Queen’s University. Dr. Moore and his research team will bring together Lyme disease stakeholders, including researchers, clinicians and patients, in order to facilitate national collaboration and to generate new knowledge to improve the diagnosis, treatment, and health outcomes for people with Lyme disease.

Infectious Diseases and Climate Change Fund

PHAC’s Infectious Disease and Climate Change (IDCC) Fund provides $2 million annually over 11 years (2017-2028) to help Canadians, communities and health professionals have the information they need to better understand their risks and take measures to protect themselves from climate-driven infectious diseases. As of November 2019, more than $3.7 million in funding has been invested to support twelve new Lyme disease projects focussed on enhancing surveillance and monitoring efforts, and developing new education and awareness resources and tools for the public and health professionals.

Current Issues: Lyme Disease and Pregnancy

Updates to U.S. Centers for Disease Control and Prevention (CDC) Website Language

On January 27, 2020, the U.S. CDC updated their website (cdc.gov/lyme) to include new language regarding transmission of Lyme disease during pregnancy. The new language states “untreated Lyme disease during pregnancy can lead to infection of the placenta. Spread from mother to fetus is possible but rare.” As the source of evidence for the updated language, CDC cites a 1997 review article of early case reports and epidemiologic studies from 1983 to 1997. The change in language on the CDC website has prompted an immediate response from media and stakeholder groups, who are calling for the Canadian government to follow U.S. recognition of mother-to-fetus Lyme disease transmission.

Federal Initiatives and Investments

PHAC and the CDC conducted a systematic review to assess the literature on Lyme disease and its effect on pregnancy and the fetus, which was published in a peer-reviewed journal in November 2018. The review concludes that, while maternal-fetal transmission is biologically plausible, more research is needed to determine whether maternal-fetal transmission occurs, and if so, whether there is any association with poor outcomes for the baby. The PHAC review is consistent with the April 2018 review done by the UK National Institute for Health and Care Excellence, both of which have indicated that there is no conclusive evidence of maternal-fetal transmission ‎of Lyme disease. 

Through the IDCC Fund, PHAC is providing funding of $525,274 to the Society of Obstetricians and Gynecologists of Canada (SOGC) to support the review of the current evidence on the effects of Lyme disease and other tick-borne diseases on pregnancy and pregnancy outcomes. The funding also supports the development of resources that will equip health care providers and women with evidence-based information and tools on Lyme disease and other tick-borne diseases during pregnancy. It is expected that the SOGC will complete this work in the coming months. 
PHAC will continue to monitor new evidence as it becomes available, including the findings of the SOGC, and is committed to providing Canadians with up-to-date information on Lyme disease so that they can take measures to protect their health.

PHAC Contact: Lindsay Colas (613) 404-6322
PHAC Approved by: Kim Elmslie, VP-IDPC (613) 954-9663
CIHR Contact: David Marchand (613) 948-5802

Measles in canada

Synopsis

There was widespread measles activity in 2019 affecting many countries (notably, the United States (U.S), the United Kingdom, and France). The World Health Organization (WHO) reported that the number of confirmed cases worldwide was almost 30% higher in 2019 compared to 2018.

Measles is relatively rare in Canada due to effective vaccination programs. However, it is important that Canadians continue to be vaccinated against measles given the travel-related risks of infection and spread to unimmunized people.

Key messages

• The health and safety of Canadians is our Government’s top priority.
• Vaccination is a safe and effective protection against measles.
• Measles is rare in Canada, thanks to vaccination.
• But this is not the case in all countries. Measles outbreaks remind us that travelers may bring the measles virus into Canada and spread it to unimmunized people.
• We will continue to provide Canadians with reliable information about vaccination and promote vaccination to protect Canadians from serious illnesses.

If pressed…

• While vaccination is not mandatory in Canada, the Government of Canada is committed to vaccination as a safe and effective public health measure that prevents disease and disability.
• Provincial and territorial governments deliver vaccination programs and determine public health requirements in their jurisdictions.

Background

Measles is a highly contagious respiratory tract infection caused by the measles virus. Measles is spread by contact with an infected person through coughing and sneezing. It is a leading cause of death among young children globally.

Measles is a notifiable disease in all provinces and territories (P/Ts). When a healthcare provider diagnoses a case of measles, notification is also made to the respective jurisdictional public health agency. This helps P/Ts implement measles prevention and control strategies as quickly as possible.

There is no specific treatment for measles. Individuals with measles should self-isolate during the infectious period to prevent infecting others. People should talk to their health care provider if they think they have measles.

Measles infections can cause complications including ear infections, pneumonia, encephalitis, seizures, and, rarely, death. Generally, the disease is more severe in children less than five years of age, adults older than 20 years of age, pregnant women and anyone with a compromised immune system. Measles during pregnancy can result in a higher risk of premature labour and low infant birth weights.

Measles Outbreaks Nationally and Internationally

As of February 21, 2020, one case of confirmed measles has been reported in Canada in 2020. This case was reported by the province of Alberta and had a history of travel to Uruguay, with transit through Argentina, Chile, and the United States.

113 cases of measles were reported in 2019, 29 cases were reported in 2018 and 45 cases were reported in 2017.

In 2019, measles cases were acquired during travel to the following countries: Vietnam, the Philippines, Ukraine, Poland, France, Pakistan, U.S., Cambodia, Thailand, China, Japan, Bangladesh, India, and the United Kingdom.

The United States Centers for Disease Control and Prevention provides monthly updates on the measles situation in the U.S. and no measles outbreaks were reported in their January 31, 2020 update. However, the Los Angeles County Department of Public Health declared a local outbreak of measles in early February involving five cases.

Since 2016, multiple large scale measles outbreaks have been reported across Europe, with almost all European countries reporting measles cases by 2017. According to the World Health Organization, cases of measles in the European Region hit a record high in 2018.

Mandatory Vaccination in Schools

Vaccination is not mandatory in Canada; however, some P/Ts may require documentation of vaccination for children to enter public schools.

To date, only British Columbia, Ontario and New Brunswick require proof of vaccination for measles and other vaccine preventable diseases (VPDs) in order to register in public schools.

Federal Role

The Public Health Agency of Canada (PHAC) works with P/Ts in the management of outbreaks of VPDs by providing technical advice and assisting with laboratory testing when requested by a P/T. P/Ts and local public health are responsible for delivering public health programs, including vaccination programs, and investigation and follow-up of measles cases and outbreaks.

The federal government has a role in regulatory approval of vaccines, vaccine safety, national surveillance for VPDs and adverse events following vaccination, bulk purchasing of vaccines, national leadership and coordination in knowledge development, innovation, and sharing of best practices.

Each week, PHAC receives measles surveillance data from P/Ts and reports cases to the Pan American Health Organization (PAHO). Weekly measles surveillance reports are publicly available on the Canada.ca website.

Measles Vaccination Coverage Rates

Measles is relatively rare in Canada due to effective vaccination programs. However, it is important that Canadians continue to be vaccinated against measles given the travel-related risks of infection and spread to unimmunized people.

PHAC estimates vaccine coverage through the Childhood National Immunization Coverage Survey (cNICS), conducted every two years. The latest survey completed in 2017 estimated that 90% of Canadian children had received at least one dose of measles vaccine by two years of age. This is below the 95% coverage target for measles vaccines.

Contact: Jennifer Pennock, Director 613-946-0491
Approved by: Gina Charos, Director General 613-960-2893

Physical activity

Synopsis

Being active is key to good health and well-being, and to preventing chronic disease.

Key messages

• The Government recognizes the importance of helping Canadians lead healthier lives and to become more physically active.
• Our Government is working with provincial and territorial governments, and other partners to support all Canadians to move more and sit less.
• Through the Government’s investment of $25 million over five years, ParticipACTION is working with its partners to support and motivate communities and Canadians to be more active.
• The Government of Canada has committed $1.2 million in project funding to support non-governmental champions in advancing federal, provincial and territorial efforts on physical activity.

Background

Canada continues to face increasingly complex health challenges. Four out of ten Canadian adults (aged 20 years and over) report having at least one of 10 common chronic diseases including heart disease, stroke, cancer, and diabetes. Levels of obesity in Canada remain high – one in three children and two out of three adults are considered overweight or obese. Physical inactivity and sedentary behaviour levels remain high, especially among children and youth. In Canada, at least four of five adults do not meet the Canadian Physical Activity Guidelines.

HESA study of level of fitness and physical activity of Canadian youth

In 2018-19, the Standing Committee on Health (HESA) undertook a study on the level of fitness and physical activity of youth. On June 17, 2019, HESA tabled their report entitled Get Canada’s Youth Moving! with six recommendations. Although the Committee requested a response, the government response was not tabled due to the dissolution of Parliament.

On October 29, 2019, ParticipACTION released its first-ever Report Card on Physical Activity for Adults in Canada, using data sources and statistics similar to those used in Public Health Agency of Canada (PHAC) surveillance products. The report assigned grades to daily behaviours, including overall physical activity (D) and sleep (B-). Grades were also assigned for strategies and investments by government (B-), as well as individual characteristics and settings/sources of influence.

Canadian children rank low in global childhood physical activity report.

According to the 2018 Active Healthy Kids Global Alliance report, Canada ranked 21st out of 49 countries based on an assessment of a range of factors including active play, organized sport and physical activity, and active transportation. Canadian data was drawn from the 2018 ParticipAction Report Card on Physical Activity for Children and Youth. That report gave Canadian children a D+ for overall physical activity, up slightly from D- in 2016. The ParticipACTION Report Card on Physical Activity for Children and Youth synthesizes Canadian data from multiple sources, including the best available peer-reviewed research, to assign evidence-informed grades across 14 indicators.

Since its inception, PHAC’s Healthy Living and Chronic Disease Prevention - Multi-sectoral Partnerships (MSP)program invests $20 million annually and leverages additional non-governmental funding to promote healthy living and prevent chronic disease, and to address the common risk factors (e.g., physical inactivity, unhealthy eating, and tobacco use) that underlie major chronic diseases (e.g., cancer, diabetes, cardiovascular disease).

The Canadian 24-Hour Movement Guidelines for the early years and for children and youth(Guidelines) were developed by the Canadian Society for Exercise Physiology (CSEP), in collaboration with PHAC and other stakeholders. The guidelines combine physical activity and sedentary behaviour guidelines and include sleep, showing the interrelationship between all three behaviours. Through funding provided by PHAC, CSEP is working with experts to develop the Canadian 24-hour movement guidelines for adults and older adults, the world’s first 24 movement guidelines for this age group. The guidelines are expected to be released in the fall of 2020.

PHAC monitors Physical Activity, Sedentary Behaviour and Sleep (PASS) and reports on a spectrum of behaviours and environments associated with active living and sleep, including sedentary behaviour, which is an independent risk factor for premature mortality and chronic disease.

Budget 2018 announced $25 million over five years for PHAC to support ParticipACTION to increase participation in daily physical activity among Canadians through the Let’s Get Moving initiative. The investment aims to change social norms through long-term multi-sectoral partnerships and coordinated public education and engagement.

Canadian Institutes of Health Research (CIHR)

Through CIHR, the Government of Canada is investing in research related to physical activity to better understand linkages between physical activity and health outcomes, and evaluate the effectiveness of physical activity interventions at a population level in Canada.

Federal/Provincial/Territorial (F/P/T) efforts on physical activity

Released in June 2018, A Common Vision for Increasing Physical Activity and Reducing Sedentary Living in Canada: Let’s Get Moving is a F/P/T policy framework to leverage action to support Canadians and communities to move more and sit less. PHAC has committed $1.2M in project funding via the MSP program to support non-governmental Champions in advancing the Common Vision’s six areas of focus over the course of two years. F/P/T governments have already put in place a range of policy and program activities to support the Common Vision, as well as non-governmental organizations such as ParticipACTION to continue to play an important role in the implementation of the Common Vision along with the physical activity sector.

Contact: Barrett Halliday, 613-946-6965
Approved by: Anna Romano, VP, 613-960-2863

Post-traumatic stress disorder (ptsd)

Synopsis

Pursuant to the Federal Framework on Post-Traumatic Stress Disorder Act, Canada’s first Federal Framework on PTSD was tabled in the House of Commons on January 22, 2020, and tabled in the Senate on February 4, 2020. The Framework was made public on February 13, 2020.

Key messages

• Our Government recognizes the tremendous impact that post-traumatic stress disorder, also known as PTSD, has on individuals, families, communities and workplaces.
• To that end, Canada’s first Federal Framework on PTSD has been developed in collaboration with partners and stakeholders and informed by the results of a national conference convened in April 2019. I was pleased to table this Framework in the House earlier this year.
• The Framework sets out our Government’s vision, guiding principles and actions in addressing PTSD, with a focus on those who face increased risks because of the nature of their jobs.
• Budget 2018 invested $20 million over 5 years to support a new national research consortium to address the incidence of Post-Traumatic Stress Injuries among public safety personnel.
• Mental health is a priority of our Government. That is why we are also investing in improving access to mental health and addictions services through our work with provinces and territories.

Background

TheFederal Framework on Post-Traumatic Stress Disorder Act came into force on June 21, 2018. The Act requires the development of a comprehensive PTSD, which was tabled in the House of Commons on January 22, 2020, and tabled in the Senate on February 4, 2020. On February 13, 2020, the release of the Federal Framework on PTSD: Recognition, Collaboration and Support was publicly announced.

To inform the development of the federal framework, in accordance with the Act, the Minister of Health convened a National Conference on PTSD in April 2019 with the Ministers of National Defence, Veterans Affairs, and Public Safety and Emergency Preparedness, partners and stakeholders, including people with lived-experience.

PTSD is a mental disorder that may occur following a potentially traumatic event involving exposure to actual or threatened death, serious injury, or sexual violence.Potentially traumatic events can include war/combat, major accidents, natural/human made disasters and interpersonal violence. PTSD can affect any person regardless of their age, culture, occupation, sex, or gender and may lead to significant distress or problems in functioning in social or family life, at work and/or at school.

PTSD often occurs with other mental disorders such as depression and substance use disorders, chronic diseases and conditions like diabetes, high blood pressure, and chronic pain, and suicidal thoughts and behaviours.

The lifetime prevalence of PTSD among adults in Canada has been estimated to be 9.2%. However, certain populations are at increased risk for PTSD. Estimates show that in Canada, 23% of public safety personnel, such as paramedics, firefighters and police, show symptoms of PTSD. According to Statistics Canada (2013), an estimated 13.1% of Canadian Armed Forces (CAF) Regular Force Veterans (former members) who were released from service during 1998 to 2012 reported being diagnosed with PTSD. According to a 2014 report, the number of active CAF Regular Force members who reported symptoms of PTSD nearly doubled from 2002 to 2013 from 2.8% to 5.3%.These estimates may not be directly comparable due to varying data collection methods.

Canadian Institutes of Health Research (CIHR)
Between 2014/15 – 2018/19, CIHR invested over $11 million in research related to post-traumatic stress disorder.

Additionally, Budget 2018 announced investments focused on addressing PTSI in public safety officers. This includes an investment of $20 million over five years to support a new national research consortium between CIHR and the Canadian Institute of Public Safety Research and Treatment (CIPSRT), to address the incidence of PTSI among public safety personnel.

Examples of recent research initiatives supported by CIHR include the PTSI Catalyst Grant competition (22 one-year grants for a total investment of $2.95 million that serve as a springboard for researchers who are increasing our understanding of how to identify, treat, and prevent PTSI among public safety personnel) and the launch of the Team Grants in PTSI competition in 2018 (an $8.4 million investment that will support four-year research projects designed to develop the new research evidence and tools needed to address gaps in PTSI among public safety personnel in Canada). The results of the Team Grant competition are expected to be available in spring of 2020.

Other Government Departments

Veterans Affairs Canada (VAC) funds a Centre of Excellence on PTSD and Related Mental Health Conditions,which opened on April 1, 2019. The mission of the Centre is to increase Canadian expertise related to Veteran and military Operational Stress Injuries, including but not limited to PTSD, and to make the expertise accessible to health care providers, people with lived experience, family-members, researchers and the Canadian public. The Centre will be a hub for knowledge translation to provide information and resources on Veteran-specific mental health treatment. The Centre will share evidence-based treatment protocols and best practices among the VAC network of Operational Stress Injury Clinics, the Canadian Forces Health Services, and to all those providing treatment and support to Veterans throughout Canada. This investment in mental health for Canada’s military and veterans represents $17.5 million over four years, and $9.2 million per year ongoing.

Post Traumatic Stress Injuries (PTSI*)

The Supporting Canada’s Public Safety Personnel: An Action Plan on PTSI was released on April 8, 2019. The Action Plan sets out to strengthen the collective understanding of PTSI through research, including applied research and treatment trials; supporting mental health resilience through evidence-based research to inform public awareness, training and other initiatives that emphasize prevention, early intervention and stigma reduction; and identifying ways in which PSP organizations can better monitor and manage the mental health of PSP through support for care and treatment. The Action Plan includes 16 Key Actions under three pillars: 1) research and data collection; 2) prevention, early intervention and stigma reduction; and 3) support for care and treatment.

*PTSI is a non-clinical term intended to capture the full range of mental injuries that can occur following a traumatic event and can include PTSD, depressive disorders, anxiety disorders, or substance use disorders.

PHAC Contact: Karen McKinnon (613) 957-7792
PHAC Approved by: Anna Romano, VP-HPCDP (613) 960-2863
CIHR Contact: David Marchand (613) 948-5802

Seasonal influenza

Synopsis

The flu season in Canada usually runs from mid-November to mid-May. Each year in Canada, seasonal influenza leads to an estimated 12,200 hospital stays and 3,500 deaths. The flu shot, recommended for all Canadians six months of age and older, is the most effective way to prevent the flu and flu-related complications, such as pneumonia.

Key messages

• The health and safety of Canadians is our Government’s top priority.
• Vaccination is the best defense against the flu. That is why we work with the provinces and territories to provide flu vaccine to Canadians every year during flu season.
• We are putting a focus on raising public awareness of the benefits of vaccination for individuals, families, and communities. We are giving Canadians the information they need to prevent illness.

If pressed…

• While vaccination is not mandatory in Canada, the Government of Canada is committed to vaccination as a safe and effective public health measure that prevents disease and disability.
• Provincial and territorial governments deliver vaccination programs and determine public health requirements in their jurisdictions.

Background

Seasonal influenza epidemics occur in Canada every year. Canada’s flu season typically runs from mid-November to mid-May and peaks during the winter months. The best time to get the influenza vaccine is between October and December; however, the vaccine can still be effective even when received during later winter months. Each year in Canada, seasonal influenza leads to an estimated 12,200 hospital stays and 3,500 deaths. The flu shot, recommended for all Canadians six months of age and older, is the most effective way to prevent the flu and flu-related complications, such as pneumonia.

Vaccine Effectiveness (VE) & Coverage

The Canadian Sentinel Practitioner Surveillance Network has published estimates of influenza vaccine effectiveness against primary care visits for influenza. Based on data from the early part of the 2019-20 influenza season up to February 1, 2020, vaccine effectiveness was estimated to be 58% for any influenza, 44% for A(H1N1), 62% for A(H3N2), and 69% for influenza B.

Interim vaccine effectiveness estimates against hospitalization for influenza are expected in March 2020. In terms of uptake, vaccination coverage estimates for the 2018-19 season was approximately 42% for Canadian adults aged 18 years and older. Among them, seniors 65 years of age and older had higher coverage rates at 70%. Influenza vaccine coverage estimates for the 2019-20 season are anticipated in March 2020.

2019-20 Influenza Surveillance in Canada

Canada participates in national and international activities to detect and monitor the spread of influenza in humans and animals. The Public Health Agency of Canada (PHAC) maintains FluWatch, Canada’s national surveillance system that monitors circulating flu viruses, activity levels, outbreaks, and hospitalizations.

As of February 15, 2020, influenza activity is elevated as expected for this time of year. The current flu season in Canada is characterized by a co-circulation of all influenza types and subtypes (A(H1N1), A(H3N2), B). This trend is also being observed internationally. Influenza A is the predominant circulating type (57% of detections) but influenza B is circulating at higher levels than usual at this point in the flu season.

The highest estimated rates of hospitalization reported by provinces and territories (P/Ts) are among children under 5 years of age and adults 65 years of age and older. The number of pediatric hospitalizations reported through sentinel hospital surveillance is well above the average over the previous five seasons. This is expected given the elevated levels of influenza B and concurrent circulation of influenza A and B. The number of adult hospitalizations reported through sentinel hospital surveillance decreased in the past week; however, the trend may be variable over the coming weeks until a consistent decrease in laboratory detections is observed at the national level.

Influenza Vaccine Development and Supply

The World Health Organization (WHO) issues recommendations each year on the composition of the influenza vaccines for the southern and northern hemispheres. These recommendations are used by national vaccine regulatory agencies and pharmaceutical companies to develop, produce and license seasonal influenza vaccines.

The P/Ts and some federal departments (Indigenous Services Canada, Correctional Service of Canada, Global Affairs Canada, Royal Canadian Mounted Police, and Department of National Defence) order the majority of their influenza vaccine through Public Services and Procurement Canada’s Bulk Procurement Program. The P/Ts use their discretion to make decisions regarding their influenza vaccination programs, including eligible populations, vaccine types and quantities.

Recommendations for Influenza Vaccination

The National Advisory Committee on Immunization (NACI), an expert advisory body to PHAC, annually reviews available scientific evidence to provide recommendations for vaccinating Canadians with seasonal flu vaccine. NACI recommends that everyone 6 months and older, without contraindications, receive an annual flu shot.
The influenza vaccine remains the best line of defense against influenza and is especially important for those at high risk of severe illness from influenza. Evidence suggests that the influenza vaccine protects pregnant women and their newborns. NACI notes that seasonal influenza vaccination provides benefits to health care workers and to the patients for whom they care. NACI considers the provision of influenza vaccination to be an essential component of the standard of care for all health care workers for the protection of their patients.

Contact: Gina Charos (613-960-4562)
PHAC Approved by: Kimberly Elmslie (613-954-9663)

Seniors health

Synopsis

Seniors are the fastest growing age group in Canada. The Health Portfolio works with a wide range of partners on health promotion, disease prevention and research to support healthy aging as a public health priority.

Key messages

• The Government of Canada is committed to helping seniors live healthy, active and independent lives.
• We are working with the provinces, territories and others to help communities become more “age-friendly,” so that seniors can live safely, enjoy good health and be active. There are more than 1400 age-friendly communities in Canada.
• In 2018, the Government of Canada invested $75 million in the Healthy Seniors Pilot Project in New Brunswick. It funds applied research initiatives that can help support seniors in their homes, communities and care facilities.
• Historic investments of $11 billion over 10 years are also supporting provinces and territories to strengthen health care, including improved access to home and community care.
• Over the last five years, the Government of Canada has also invested more than $450 million to support innovative research on aging that aims to improve the quality of life and health of older Canadians.

Background

Healthy aging initiatives can prevent illness and injury, reduce the impact of existing health conditions, help people recover from ill health and frailty, increase independence and improve quality of life.

Health Portfolio Initiatives

The Public Health Agency of Canada (PHAC) monitors and reports on the health of older Canadians, and promotes their health and wellbeing. PHAC works with stakeholders to ensure that seniors have opportunities, environments and support to live as healthily as possible. Key areas of work include:

• Age-friendly communities (AFC),where older adults and community leaders work to create supportive physical and social environments.
• Promoting falls prevention approaches by increasing public awareness, and improving the availability of data to inform public health decision-making.
• Raising awareness of seniors’ mental health and working with partners to develop resources for seniors, families and health professionals.

In June 2019, A Dementia Strategy for Canada: Together We Aspire was released. Budget 2019 announced $50 million over 5 years for initiatives to support the strategy’s implementation.

Budget 2018 provided $75 million to support the Healthy Seniors Pilot Project in New Brunswick. This Project will test innovative solutions that support healthy aging. Promising practices will be shared across Canada.

In Budget 2017, the Government of Canada committed $11 billion over 10 years in new funding for provinces and territories to improve access to home care and mental health services for Canadians, including home-based palliative care and community-based care. PHAC is also providing $250,000 to Parachute Canada for its Pan-Canadian Seniors’ Fall Prevention Network project which includes creation of an online hub to improve access to fall prevention resources.

The Canadian Institutes of Health Research (CIHR) invested more than $450 million to support research on aging between 2014-15 and 2018-19, including research related to mobility, dementia, falls prevention, late life issues and palliative care, age-friendly communities, and technological innovations. CIHR supports the Canadian Longitudinal Study on Aging, a national, long-term study to help us better understand the determinants of healthy aging. CIHR’s Transitions in Care initiative supports research that transforms health systems to optimize the outcomes of individuals experiencing transitions in care, including older adults. CIHR’s Healthy Cities Research Initiative will build capacity and generate evidence on interventions which improve population health and health equity, including interventions that create healthy, active, inclusive cities for older adults.

International Initiatives

In 2016, Canada endorsed the World Health Organization’s (WHO) Global Strategy and Action Plan on Ageing and Health. The WHO is developing a proposal for a Decade for Healthy Ageing (2020-2030) in consultation with Member States.

PHAC Contact: Karen McKinnon (613) 957-7792
PHAC Approved by: Anna Romano (613) 960-2863
CIHR Contact: David Marchand (613) 948-5802

Suicide prevention in canada

Synopsis

Suicide is a significant public health issue that affects people of all ages and backgrounds across Canada. The Canada Suicide Prevention Service, providing 24/7 toll-free crisis support, was launched by Crisis Services Canada in November 2017.

Key messages

• The Government recognizes the impact suicide has on families and communities.
• That is why we are investing $25 million over 5 years to implement and sustain a fully operational pan-Canadian suicide prevention service.
• This funding will build on the Canada Suicide Prevention Service, which is providing phone and text support.
• Supporting the mental health of Canadians is fundamental to suicide prevention. That is why the Government of Canada provided provinces and territories with $5 billion over 10 years to improve access to mental health and addictions services.

If pressed on the implementation of the pan-canadian service

• The Public Health Agency of Canada is currently reviewing proposals by organizations interested in delivering a pan-Canadian Service.

If pressed further

• As this is a failsafe endeavor, it is critical to take the time to do our due diligence. A decision is expected soon.

Background

Approximately, 10 people die by suicide every day in Canada. There were over 3,800 deaths by suicide in Canada in 2018. Suicide was the 9th leading cause of death among all Canadians in 2018, and the 2nd leading cause of death among youth aged 15 to 24 and adults aged 20-34, behind unintentional injuries (Statistics Canada). There is no single cause that explains or predicts suicide; a combination of factors are associated with suicide, such as mental illness, physical health, personal issues and loss, childhood abuse and neglect, and exposure to trauma.

The Public Health Agency of Canada (PHAC) has provided proof of concept funding to Crisis Services Canada (CSC) in the amount of $4.3 million over five years (2015/16 to 2019/20) to support the development of the Canada Suicide Prevention Service (CSPS), a national phone, text and chat suicide prevention service that links existing telephone and distress and crisis infrastructures throughout Canada. Quebec is serving its residents through its provincial suicide prevention line: 1-866-APPELLE.

Budget 2019 announced an additional $25 million over 5 years and $5 million ongoing to implement and sustain a fully operational pan-Canadian suicide prevention service. This will provide people across Canada with access to 24/7/365, bilingual crisis support from trained responders, using the technology of their choice (voice, text or chat). PHAC launched an Invitation to Submit a Funding Request (ISFR) on July 8, 2019, for organizations interested in leading a pan-Canadian suicide prevention service, with the deadline for this solicitation ending on October 31, 2019. PHAC is currently finalizing the review of applicant proposals.

The Federal Framework for Suicide Prevention was made publicly available November 2016. It focuses on raising public awareness, reducing stigma, disseminating information and data, and promoting the use of research and evidence-based practices. Progress Reports on the Framework were released in December 2016 and December 2018 on Canada.ca, with the next report planned for release in December 2020.

Artificial Intelligence to Improve Understanding of Suicide-Related Verbalization

In 2018, PHAC funded a pilot project that uses artificial intelligence to collect data on suicide-related verbalization. PHAC will analyze overall patterns in social media posts to identify trends and risk factors among diverse populations that could enhance suicide prevention efforts. Since PHAC will only have access to aggregate-level data, this project will not be able to predict suicides by individuals or include any interaction with people on social media.

Motion 174 – A National Suicide Prevention Action Plan

In April 2018, MP Charlie Angus (NDP, Timmins-James Bay) sponsored motion M-174, calling for the Government of Canada to establish a national suicide prevention action plan. On May 8, 2019, parliamentarians voted unanimously in favour of M-174, though it is non-binding. Some of the proposed actions in the plan are already being addressed in the Federal Framework. PHAC will facilitate the coordination and collaboration on elements of the action plan with relevant departments, agencies and key stakeholders through its convening role on the Federal Framework for Suicide Prevention. An update on M-174 will be included under the next Framework progress report (December 2020).

3-Digit Suicide Prevention National Telephone Line – 9-8-8 Campaign in Canada

In line with the efforts of the U.S. and the U.K. to designate memorable 3-digit numbers for their suicide prevention national lines, Ms. Kathleen Finlay of the Zer0Now Campaign recently launched an online and social media campaign calling for the introduction of 9-8-8 in Canada. Senator Denise Batters (Conservative, Saskatchewan) has actively championed the campaign online. PHAC will work with the new funding recipient leading the pan-Canadian Suicide Prevention Service to develop an approach to introduce a 3-digit number in the future.

PHAC Contact: Pamela Ponic (613) 954-2252
PHAC Approved by: Anna Romano, VP-HPCDP (613) 960-2863
CIHR Contact: David Marchand (613) 948-5802

Tuberculosis

Synopsis

Tuberculosis (TB) is a preventable and curable infectious disease, and yet it remains a public health challenge. Although Canada is a low-incidence country, Indigenous Peoples and foreign-born individuals from high-incidence countries are disproportionately affected.

Key messages

• Our Government recognizes the impact of tuberculosis on individuals and families.
• We are working with provincial, territorial, and Indigenous partners to reduce rates of tuberculosis. We want to improve access to prevention, treatment and care in communities most at risk for the disease.
• Our approach is focussed on removing barriers such as stigma, and providing culturally appropriate services and treatment.
• We are committed to our work with all partners to eliminate tuberculosis and to address its underlying causes such as poverty, food insecurity and inadequate housing.

Background

Two populations are at highest risk for TB in Canada:

• Indigenous populations (In 2017, the rate of TB among Inuit was more than 300 times higher than that of the Canadian-born, non-Indigenous population).
• Foreign-born population (In 2017, accounted for 71.8% of reported cases).

High rates of TB among Indigenous populations are associated with social determinants of health, such as: poverty, food insecurity, poor housing conditions (particularly overcrowding and inadequate ventilation), and higher rates of other health problems (e.g. diabetes).

Federal Role

TB is a disease of social inequality. Addressing it requires multi-sectoral action on the part of governments, industry and civil society. Government of Canada priorities focusing on reconciliation with Indigenous Peoples, food security, housing, poverty reduction and job creation are helping to leverage public health efforts at the local level.

Provinces and territories are primarily responsible for the delivery of health care to eligible residents under provincial and territorial health insurance plans. As such, the essential components of an effective TB prevention and control program, including contact tracing, outbreak management, and monitoring and evaluation, are typically coordinated and delivered by the provinces and territories.

The Public Health Agency of Canada (PHAC) supports TB prevention and control through national surveillance; epidemiological support; deploying National Emergency Strategic Stockpile assets; and diagnostic/references services to support the detection and identification of TB.

PHAC has helped fund projects aimed at reducing the rates of TB in at-risk communities. Since 2015, PHAC has invested more than $630,000 in three projects in high-burden Indigenous communities in Nunavik (northern Quebec), Saskatchewan and Northwest Territories. Between 2016 and 2019, a study led by the Ottawa Hospital Research Institute to assess the uptake of a shorter-course drug treatment for latent TB infection at sites in Iqaluit and Ottawa received $520,000 from PHAC and $230,000 from Health Canada. Currently, in fiscal year 2019-2020, PHAC is providing more than $500,000 in funding for projects that will help to address TB in people living in Canada who are from countries where rates of the disease are high. These projects aim to reduce stigma and improve access to care.

Inuit Crown Partnership Committee – Toward TB Elimination in Inuit Nunangat:

In March 2018, the Government of Canada and Inuit Tapiriit Kanatami (ITK) announced their commitment to work collaboratively towards eliminating TB across Inuit Nunangat by 2030 and reducing active TB by at least 50% by 2025. Budget 2018 earmarked $27.5M over five years to support this work.

The release of the Inuit TB Elimination Framework in December 2018 marked an important milestone in the journey towards TB elimination in Inuit Nunangat and is helping shape action plans in each of the four Inuit regions. As Inuit continue on the path of self-determination, distinctions-based, culturally appropriate care is fundamental to how TB services are delivered.

Contact: Howard Njoo (613) 960-1940
Approved by: Kim Elmslie, VP-IDPC (613) 954-9663

Vaccination

Synopsis

Vaccination remains one of the most effective public health measures to protect Canadians against vaccine preventable diseases (VPDs), such as measles, mumps and tetanus. Despite this, Canada is not achieving its vaccination coverage goals. VPDs remain a public health concern as they can be transmitted among susceptible people such as children, individuals with a weakened immune system, the elderly, and those who do not have up-to-date vaccinations.

Key messages

• Our government recognizes the importance of vaccination against infectious diseases for the health and safety of Canadians.
• Recent outbreaks of vaccine preventable diseases, like measles, are a reminder that these diseases remain a threat to public health.
• We are working to increase vaccination rates in Canada and provide better information to Canadians and health professionals.

If pressed…

• While vaccination is not mandatory in Canada, the Government of Canada is committed to vaccination as a safe and effective public health measure that prevents disease and disability.
• Provincial and territorial governments deliver vaccination programs and determine public health requirements in their jurisdictions.

Background

In Canada, vaccination is a shared responsibility among the federal, provincial and territorial (F/P/T) governments. The majority of costs are borne by the provinces and territories (P/Ts), who are responsible for the planning and delivery of vaccination programs. Vaccines are not covered by the Canada Health Act, and are therefore provided as supplementary services at the discretion of P/Ts.

Federal Role

The federal government has a role in vaccine regulatory approval, vaccine safety, monitoring, and national surveillance of vaccine preventable diseases (VPDs) and adverse events following immunization. Its role also includes coordinating the bulk purchasing of vaccines for all jurisdictions and national leadership on the development of evidence-based public health recommendations and educational materials on the importance of vaccination. In addition to ongoing funding of approximately $29 million per year to support vaccination programming by the Public Health Agency of Canada (PHAC), Budget 2016 invested an additional $25 million over five years (2016-2021) to increase vaccination rates in order to protect Canadians against VPDs.

Surveillance and Coverage Surveys

To help ensure the ongoing health and safety of Canadians, particularly children, immunocompromised (weakened immune system) individuals, and the elderly, high levels of vaccination coverage for VPDs are required. Vaccination coverage goals are 95% for infants and children, 90% for adolescents, and 80-90% for adults depending on the VPD. F/P/T vaccination coverage goals and VPD targets were updated in December 2017, and Canada will monitor its progress against these goals. The Childhood National Immunization Coverage Survey (2017) showed that while vaccination coverage in Canada is good, Canada is not reaching national coverage goals. For example, only 90% of children received the measles vaccine by age 2, below the 95% coverage goal.

Vaccine Hesitancy

The World Health Organization (WHO) has identified vaccine hesitancy as one of 10 threats to global health in 2019, threatening to reverse the progress that has been made in addressing VPDs. Addressing vaccine hesitancy is a priority for PHAC. Work is underway to enhance educational and guidance tools and interventions, close knowledge and research gaps, and improve coverage data.

Immunization Research

PHAC and the Canadian Institutes of Health Research (CIHR) are investing in vaccine-related research through mechanisms such as the Canadian Immunization Research Network and the Improved Immunization Coverage Initiative. Research areas include innovations in vaccine development, clinical trials, and public attitudes and behaviours regarding vaccines. In June 2019, the Government of Canada announced an investment of $10 million over 5 years to support national cervical cancer research, studying human papillomavirus (HPV) vaccination and screening methods.

Immunization Partnership Fund

Of the Budget 2016 funding, $21.8 million has been dedicated to PHAC’s Immunization Partnership Fund, a grants and contributions program intended to improve vaccination coverage in three ways: supporting health care providers to vaccinate patients; increasing demand for vaccination among Canadians; and enhancing access to vaccination services. For example, the Fraser Health Authority in British Columbia is receiving funding to map vaccination coverage in order to develop tailored services, including mobile vaccination clinics, to reach groups who face barriers accessing vaccination services.

Vaccine Recommendations

PHAC provides recommendations on the use of vaccines in Canada for public health programs based on advice from its external advisory body, the National Advisory Committee on Immunization. This group of experts provides technical/scientific analysis and recommendations on new and existing vaccines, which now include programmatic considerations such as economics and ethics. P/Ts use these recommendations to assist in planning their vaccination programs.

Vaccine Safety

Health Canada conducts rigorous scientific review and testing of vaccines to assess their quality, safety, and efficacy before they are approved for use in Canada. Once a vaccine is authorized for use in Canada, vaccine safety is monitored to detect and respond to adverse events.

Contacts: Gina Charos (613) 960-2893
Approved by: Kim Elmslie, VP-IDPC (613) 954-9663

HC LED QP Notes

Cannabis: access to cannabis for medical purposes framework

Synopsis

• The Government is committed to ensuring that individuals who require cannabis for medical purposes have reasonable access to legal and quality-controlled products. The Cannabis Act preserves and builds on the medical access program.

Potential question

• How will the Government ensure that patients continue to have access to cannabis?
• How is the Government addressing abuses of the medical access system, while ensuring that patients continue to have reasonable access to cannabis?

Key messages

• Our Government is committed to ensuring that individuals who require cannabis for medical purposes have reasonable access to legal and quality-controlled products.
• The Cannabis Act provides distinct channels for access to cannabis for medical purposes for individuals who have the support of their health care practitioner.
• Within the framework for reasonable access, we are working to reduce the potential for abuse in partnership with health care profession regulators, municipalities and police.
• The Government continues to actively monitor the medical access program and will evaluate the framework within 5 years of the coming into force of the Cannabis Act.

If pressed on the impacts of the cannabis act on patients

• When the Cannabis Act and Cannabis Regulations came into force in October of 2018, targeted improvements were made. For instance, patients:
  • can change to another federally licensed seller more easily because they can transfer their medical document;
  • no longer have personal storage limits or the 30-day limitation period for the purchase of cannabis from a federally licensed seller; and
  • have access to a broader range of products.
• Improvements were also made to reduce the risk of abuse of the cannabis for medical purposes program. Under the Cannabis Regulations, Health Canada has the power to refuse or revoke a registration for an individual to produce their own cannabis for medical purposes in order to protect public health or public safety.

If pressed on supply issues for patients

• Health Canada closely monitors production and inventory levels and the availability of cannabis for medical purposes.
• Health Canada expects that holders of a licence for sales for medical purposes will take reasonable steps to ensure that registered patients continue to have access to the products they need for medical purposes.
• A number of licensed sellers have committed publicly to prioritize registered patients over other sales.‎
• It is expected that any localized and product-specific shortages will become far fewer in number as the overall supply chain grows and gains experience.

If pressed on limited number of authorized health products containing cannabis

• With the coming into force of the Cannabis Act, Health Canada clarified the rules for prescription health products containing cannabis that make authorized health claims.
• By adding phytocannabinoids to the Prescription Drug List, authorized health products containing cannabis, such as Sativex, remain subject to appropriate requirements of both the Cannabis Act and the Food and Drugs Act.
• This maintained the requirement for oversight by a health practitioner for health products containing cannabis and helped ensure that these products are used appropriately, just like any other prescription medication
• In addition, Health Canada recently completed a public consultation on health products containing cannabis. The department is committed to seeking external scientific advice on the appropriate level of evidence needed to determine whether potential new health products containing cannabis could be used safely without a doctor’s oversight going forward.

If pressed on complaints regarding personal production with a health canada authorization

• Although the Government cannot comment on specific cases, all persons authorized to produce a limited amount of cannabis for medical purposes must abide by the law and operate within the limits set out when they were registered at all times.
• It is illegal for these individuals to provide or sell cannabis to anyone else.
• In addition, under the Cannabis Regulations, Health Canada has the power to refuse to register or revoke a registration to protect public health or public safety, including preventing cannabis from being diverted to the illicit market.
• Health Canada will not hesitate to take action if non-compliance with the regulations is identified.
• Health Canada also encourages all provinces, territories and municipalities to use the tools at their disposal to ensure that individuals meet all applicable standards and bylaws, including local by-laws about zoning, noise, odour, and fire safety.

If pressed on personal registration certificates granted to individuals subject to criminal investigations

• Our Government remains committed to ensuring patients have access to cannabis for medical purposes, while providing safeguards to reduce the risk of abuse of the system. 
• Successive court decisions have established the right of individuals to have reasonable access to cannabis for medical purposes.   
• The information submitted in an application to produce cannabis for medical purposes is rigorously reviewed by Health Canada and the registration is refused if it does not meet the requirements, or contains information that is false or misleading.
• Investigations and/or charges are not enough to deny medical cannabis to patients who have the support of their health care practitioner to use cannabis for their medical needs. Should a conviction occur, Health Canada would review the information to determine if enforcement actions were warranted, including possible revocation of the registration.

If pressed on the canadian medical association's position that the medical system should be abolished

• Successive court decisions have established the right of individuals to have reasonable access to cannabis for medical purposes.
• Determining whether cannabis is appropriate to treat an individual’s symptoms is a decision best made through a discussion with a health care practitioner.
• Health Canada has published an updated summary of the peer-reviewed scientific and medical literature on the effects, risks and harms of cannabis for medical and non-medical purposes.
• This information can help Canadians and their health care practitioners make informed decisions about the benefits and risks of using cannabis for medical purposes.
• Our Government continues to actively monitor the medical access program and will evaluate the framework within 5 years of the coming into force of the Cannabis Act.

Background

Medical Regime

• As of the end of September 2019, 369,614 medical clients were registered with federally licensed sellers (Note: these are not always unique individuals as individuals may be registered with more than one licensed seller, provided an original medical document was used with each registration).
• As of September 2019, 29,193 individuals were registered with Health Canada for personal or designated cultivation of cannabis for their own medical purposes.
• Between June and September, 2019, 5,600 kilograms of dried cannabis and 18,424 litres of cannabis oil were sold for medical purposes.
• Medical client registrations and sales of cannabis for medical purposes have remained relatively stable since October 2018.

Authorizations for personal or designated production

• Canadians who have been authorized by their health care practitioner can access cannabis for medical purposes by producing a limited amount of cannabis or by designating someone to produce it for them.
• Personal and designated production are subject to strict regulatory requirements, which are designed to ensure that cannabis is consumed only with the approval and under the supervision of an authorized health care practitioner.
• Health Canada reviews all applications for personal or designated production to ensure that the regulatory requirements are met. Health Canada also confirms that the health care practitioner is authorized by—and in good standing with—the relevant provincial or territorial regulatory health authority, and that the medical document is an original that has not been altered or falsified.
• Once a registration certificate is issued, the personal or designated producer may not produce in excess of the maximum limits outlined in a registration certificate, and may not sell cannabis to any person. Selling cannabis without authorization is a criminal offence. A maximum of four registrations are permitted per production site. Only the individuals authorized to produce a limited quantity of cannabis for their own medical purposes, or the person designated to produce it for them, can tend to the plants.
• Health Canada appreciates that, as in any regulatory framework, there will be instances where individuals choose to operate outside of the law. Health Canada supports law enforcement representatives on a daily basis by providing a dedicated service 24 hours a day and seven days a week to confirm, when necessary, that specific individuals are authorized to produce a limited amount of cannabis for medical purposes.
• Health Canada has the ability to inspect a production sites if it is not the registrant’s home to ensure it is abiding by the terms set out in the individual’s registration certificate.

Contact: Todd Cain (LMA) (613) 668-2460; John Clare (613) 941-8371
Approved by: Jacqueline Bogden, ADM, Controlled Substances and Cannabis Branch

Cannabis product recall

Synopsis

• On October 17, 2018, the Cannabis Act came into force, setting out strict rules controlling cultivation, processing and other activities with cannabis.
• Health Canada has a comprehensive process in place to work with the affected parties in the event of a cannabis product recall.

Potential question

• In light of recent product recalls, what has Health Canada/the Minister done to ensure appropriate measures have been taken to protect the health and safety of Canadians? How has the contaminated product made its way onto shelves and into consumers’ hands?

Key messages

• Ensuring the integrity of Canada's legal cannabis production system is a priority for our Government.
• That is why the Cannabis Act contains multiple measures that are designed to protect the health and safety of Canadians.
• These measures include stringent requirements around the production and testing of cannabis products and record keeping, inventory controls and reporting that enable the efficient recall of a cannabis product, if needed.

If pressed on an incident

• Health Canada takes complaints related to the activities of licensed producers seriously and follows up on all allegations, as appropriate.
• Health Canada officials are aware of the situation and are working with the affected parties to recall any affected product while the company continues to investigate this issue.
• If necessary, the Department will not hesitate to use the enforcement tools available under the Cannabis Act to ensure compliance.

If pressed on recall process

• Health Canada works closely with licence holders and provincial and territorial governments to coordinate the recall of products that have been sold in their jurisdiction.
• In an effort to ensure that Canadians are informed, Health Canada proactively publishes notices of all product recalls related to cannabis on Health Canada’s online recall database.

If pressed on the product quality requirements

• The production of cannabis is subject to some of the most stringent requirements in the world. These requirements are designed to protect the health and safety of Canadians.
• Licence holders are required to meet strict quality standards in their facilities, including testing every product for contaminants, such as mould or unauthorized pesticides, before products can be released for sale to the public.
• These standards and other requirements, including through unannounced inspections, are rigorously enforced by Health Canada to monitor and verify compliance with the regulations.

Background

• Ensuring efficient, timely and accurate communications with the public and amongst licence holders and government regulators is a priority for Health Canada. Health Canada proactively notifies provincial and territorial governments of a product recall when affected products have been sold or distributed in their jurisdiction. Health Canada also updates its recalls and safety alerts website.
• If a licence holder is suspected to be in contravention of federal regulations, the Cannabis Act contains a number of enforcement tools that may be considered in determining the appropriate actions to prevent or address non-compliance, based on a review of the situation and all relevant information, including the health or safety risk and the compliance history of the individual or corporation.
• These tools include measures ranging from compliance promotion and awareness, which are intended to educate and prevent non-compliance, up to measures intended to correct non-compliance or address a public health or safety risk, such as the issuance of a warning letter, suspension or cancellation of a federal licence or the issuance of a ministerial order or an administrative monetary penalty (up to $1 million).
• Since the Cannabis Act has been in force, there have been 18 voluntary recalls initiated by licence holders between November 2018 and December 2019 which affected or had the potential to affect Canadians:
  • RedeCan: voluntary recall in November 2018 due to the presence of mould, affecting 13,334 units sold.
  • Bonify: voluntary recall in December 2018 due to the presence of microbial and chemical contaminants, affecting 52 units.
  • Bonify: voluntary recall in December 2018 due to record keeping or a labelling error, affecting 5,883 units sold.
  • Up Cannabis: voluntary recall in January 2019 due to the presence of mould, affecting 1,428 units sold.
  • CannTrust: voluntary recalls in January 2019 due to labelling errors, affecting 2,653 units sold. 
  • Aurora: voluntary recall in February 2019 due to labelling error, affecting 2,180 units sold.
  • Tweed: voluntary recall in March 2019 due to labelling error, affecting 13,575 units sold.
  • Blissco Holdings Ltd: voluntary recall in April 2019 due to labelling error, affecting 720 units sold.
  • Broken Coast Cannabis: voluntary recall in April 2019 due to labelling error, affecting 11 units sold.
  • High Park Farms: voluntary recall in April 2019 due to labelling error, affecting 1,872 units sold.
  • Tweed: voluntary recall in May 2019 due to labelling error, affecting 1,240 units sold.
  • Zenabis: voluntary recall in June 2019 due to labelling error, affecting 204 units sold.
  • Aurora: voluntary recall in September 2019 due to labelling error, affecting 3,060 units sold.
  • Hexo: voluntary recall in September 2019 due to labelling error, affecting 16,818 units sold.
  • Emblem: voluntary recall in September 2019 due to labelling error, affecting 484 units sold.
  • Aphria: voluntary recall in October 2019 due to labelling error, affecting 1,478 units sold.
  • Zenabis: voluntary recall in December 2019 due to labelling error, affecting 165 units sold.

Contact: David Pellmann, Director General, Compliance, CSCB (613-948-6030)
Approved by: Jacqueline Bogden, ADM, Controlled Substance and Cannabis Branch

Amended regulations under the cannabis act
(regulations for edible cannabis, cannabis extracts and cannabis topicals)

Synopsis

• Parliament established a deadline of October 17, 2019 for the new classes of cannabis products to be added to Schedule 4 of the Cannabis Act, thereby permitting their legal sale. Amendments to the Cannabis Regulations came into force on the same day (October 17, 2019).
• The amended regulations set out the rules governing the legal production and sale of edible cannabis, cannabis extracts, and cannabis topicals. These new cannabis products became available for purchase by adult consumers in mid-December 2019.
• The amended regulations seek to reduce the public health and public safety risks associated with the new cannabis products, such as appeal to youth, overconsumption, and accidental consumption.
• The expert Task Force on Cannabis Legalization and Regulation recommended permitting legal access to regulated, quality controlled products as a way to protect Canadian consumers from the inherent risks and harms of illegal products, which are not subject to oversight or controls.

Potential question

• Why has the Government introduced new cannabis products given their risks such as accidental consumption and overconsumption?
• How is the Government addressing the appeal of these new cannabis products to youth?
• How will the Government reduce public health and public safety risks of the new cannabis products?

Key messages

• Parliament established a deadline of October 17, 2019 for the new cannabis products to be permitted for legal sale.
• Parliament recognized that providing legal access to quality-controlled products can help protect those who choose to consume cannabis from the inherent risks and harms of the illegal market, where there are no standards or oversight for quality control or safety.
• The expert Task Force recommended that the legal sale of a broad range of cannabis products be permitted in order to displace the illegal market, and that these products be subject to strict regulatory controls.
• Strict regulations have been put in place to protect consumers. Cannabis products must be produced in licensed facilities that are subject to Health Canada inspections and according to strict requirements.
• Health Canada has made available extensive public education materials to help ensure adult consumers have access to evidence-based information to help lower the risks to their health and safety.

If pressed on public health and safety risks associated with cannabis products

• Our Government recognizes that edible cannabis, cannabis extracts, and cannabis topicals present their own unique health and safety risks.
• It is also recognized that strict and clear controls on the production, promotion, packaging and labelling and sale ‎of cannabis products are one cornerstone of the public health approach.
• The amended Cannabis Regulations will reduce the public health and public safety risks associated with cannabis products, including any appeal to youth, and the risks of food-borne illness, accidental consumption, and overconsumption.
• Health Canada continues to undertake public education efforts designed to help Canadians understand the public health and public safety risks associated with the new cannabis products as well as the importance of storing cannabis safely and securely away from children, youth, and pets.
• Our Government continues to work closely with the provinces and territories, Indigenous communities, the regulated industry, public health organizations, and law enforcement to support the effective implementation of the amended Cannabis Regulations.

If pressed on the regulations

• The regulations contain important safeguards to mitigate risks, including:
• Limits on the total amount of tetrahydrocannabinol (THC) in these new products to minimize the risks of accidental consumption and overconsumption;
• Restrictions on the use of certain ingredients, such as sweeteners, to reduce the appeal to youth, or those ingredients that have public health risks, such as nicotine;
• Packages that meet the existing plain packaging requirements and are child-resistant;
• Labels that display the standardized cannabis symbol and a health warning message; and
• Strict prohibitions on health claims that might encourage the consumption of cannabis; on nutrient content claims in edible cannabis; and on representations that associate cannabis products with alcoholic beverages or tobacco products.

If pressed on why canada is regulating access to cannabis vaping products given the link between vaping thc and some vaping-associated lung illness cases in the united states

• Parliament established a deadline of October 17, 2019 for the new cannabis products to be permitted for legal sale.
• Parliament recognized that providing legal access to quality-controlled products can help protect those who choose to consume cannabis from the inherent risks and harms of the illegal market, where there are no standards or oversight for quality control or safety.
• Strict regulations have been put in place to protect consumers. Cannabis vaping products must be produced in licensed facilities that are subject to Health Canada inspections and according to strict requirements.
• Cannabis vaping products cannot contain anything that may cause injury to the health of the consumer. For example, they are not permitted to contain any added colouring agents, mineral nutrients or vitamins, including vitamin E acetate, a chemical of concern in the US cases.
• Licensed processors are responsible for making sure that all their products meet the strict requirements set out in the Cannabis Act and the Cannabis Regulations and do not cause injury to the consumer.

If pressed on the production and sale of cannabis products

• A licensee must hold a processing licence issued under the Cannabis Act to produce edible cannabis, cannabis extracts, and/or cannabis topicals. Licence holders must adhere to strict regulatory requirements, including implementing good production practices, conducting mandatory testing, and following restrictions on ingredients.
• Licensed processors are also required to provide Health Canada with 60 days’ notice in advance of selling a cannabis product for the first time in Canada.
• This notice provides Health Canada with an opportunity to intervene before a product enters the market if the Department has concerns or questions.
• Health Canada does not approve cannabis products before they are sold, but it may conduct compliance verifications following these notifications.
• Licence holders are responsible for making sure any new product meets all the requirements set out in the Cannabis Act and the Cannabis Regulations.
• New products are appearing gradually in physical and online stores.

If pressed on if there is increased appeal and availability of cannabis products to young persons following the legalization of edible cannabis, extracts, and topicals (promotion, packaging, and labelling)

• Protecting young people from the harms associated with cannabis and reducing their access is a key objective of the Cannabis Act and the Cannabis Regulations.
• To that end, the Act and its regulations contain a number of important controls. Promotion is prohibited except in limited circumstances where it cannot be seen by youth – and all promotion – regardless of location, cannot be appealing to young persons.
• Similarly, cannabis cannot be packaged and labelled in a manner that is appealing to youth – in fact, all cannabis must be sold in plain, child resistant packages that do not associate the product with alcohol or tobacco brands or products.
• Cannabis products may only be sold by provincially or territorially authorized stores to adults – and it is prohibited to sell any product that is reasonably appealing to young persons.
• Health Canada is closely monitoring rates of cannabis use by Canadian youth and will take action as necessary to make sure the government achieves its objectives.

If pressed on public education efforts

• Public education and awareness is a fundamental component of the Government’s public health approach to reducing the harms associated with cannabis.
• Our Government continues its extensive public education efforts—in collaboration with provinces and territories, Indigenous partners and other organizations—to help Canadians understand the health effects of cannabis use, the implications of cannabis on travel and crossing the border, workplace impairment, and the risks and consequences of drug-impaired driving.
• Health Canada published new evidence-based resources and updated content on its website about the new cannabis products and lower-risk use to support consumers in making informed decisions.
• Health Canada has published an updated Consumer Information Sheet, which will continue to be provided to consumers of cannabis at the point of sale.
• Health Canada continues to share information on lower-risk use practices and to communicate about the importance of storing cannabis safely and securely, away from children, youth and pets.

Background

On October 17, 2019, the amended regulations under the Cannabis Act came into force, setting out the rules governing the legal production and sale of edible cannabis, cannabis extracts, and cannabis topicals. These new classes of cannabis products became available for purchase in mid-December 2019.

The expert Task Force on Cannabis Legalization and Regulation recommended that the Government of Canada permit the legal sale of a diverse range of cannabis products to displace the illegal market where unregulated products are not subject to oversight for safety or quality control and that the products be subject to strict regulatory controls. The amended regulations seek to reduce the health and safety risks associated with these new classes of cannabis (including their appeal to youth and the risks of accidental consumption, and overconsumption). These controls include: restrictions on product composition and ingredients, tetrahydrocannabinol (THC) limits, and new requirements pertaining to packaging and labelling, good production practices and recordkeeping.

In order to sell the new classes of cannabis products, federally licensed processors will need to amend their licence and attest that all of the regulatory requirements specific to the new cannabis products have been met. Consistent with the Cannabis Regulations (in force prior to October 17, 2019), licensed processors will need to provide Health Canada with a written notice at least 60 days before making a new cannabis product available for sale.

Contact: John Clare, DG, Strategic Policy: (613) 941-2045
Approved by: Jacqueline Bogden, ADM, Controlled Substances and Cannabis Branch

Climate change and health

Synopsis

• The World Health Organization has called climate change the greatest threat to human health in the 21st century.
• Canada is warming at twice the rate of the global average, and faces a broad range of health threats due to its diverse geography and various climatic zones. Action is needed to protect Canadians.
• The impacts of climate change through climatic events (e.g., floods, severe storms, droughts, wildfires, extreme heat events), as well as increased air pollution, climate-driven infectious diseases (tick- and mosquito-borne diseases), and impacts on food and water safety and security are already being felt across Canada and are affecting the health and well-being of Canadians, particularly populations at greater risk.

Potential question

• What is the Government doing to protect the health of Canadians from the impacts of climate change?

Key messages

• The Government of Canada is committed to taking action to protect Canadians from the impacts of climate change.
• The Government of Canada recognizes that climate change is having an impact on the health and well-being of Canadians particularly for populations at greater risk such as children and seniors.
• Through Budget 2016 and Budget 2017, the Government of Canada is investing $125 million over 11 years to protect the health of Canadians from the impacts of climate change.

If pressed on extreme heat

• The Government of Canada is helping to protect Canadians by working with communities and regions across the country to develop or improve warning and response systems for heat events.
• Our Government continues to engage provinces, territories and health partners across Canada to share their experiences with extreme heat, develop best practices, and foster collaboration to reduce the health impacts of extreme heat events on Canadians.

If pressed on climate change impacts on health

• The Government of Canada is investing in research and taking action to protect Canadians from some of the most pressing issues, including extreme heat and Lyme disease.
• Our Government is educating health professionals how to identify and treat these illnesses, educating Canadians on how they can protect themselves and their families, and working with local health authorities to support action in our communities.

If pressed on climate driven infectious diseases (i.e. lyme disease)

• The Government of Canada recognizes that climate driven infectious diseases such as Lyme disease are emerging in many parts of the country, due in part to climate change, and we are committed to reducing the public health risk associated with these diseases.
• Through the establishment of the Infectious Disease and Climate Change Fund, up to $2 million in annual funding over the next 11 years is available to help Canadians, communities and health professionals have the information they need to take measures to protect themselves from climate-driven infectious diseases.
• The Government of Canada recently announced an investment of over $5M in funding for Lyme disease to increase Canada’s capacity to respond to the health impacts Lyme disease, including enhanced surveillance of Lyme disease, education and training for both the public and health care providers, and research on diagnosis and treatment. This includes support for a new Pan-Canadian Lyme Disease Research Network.

If pressed on federal leadership to support health systems

• In June 2018, the Government launched the HealthADAPT Climate Change and Health Adaptation Capacity Building Program and is providing $3 million to support the health sector to become more resilient to the impacts of climate change on health.

If pressed on climate change and impacts on mental health

• Climate change is increasingly having an impact on the mental health of Canadians. To better understand this issue, the Government is conducting a national assessment of the impacts of climate change on health.
• Our Government is also supporting mental health services across the country. Through Budget 2017, the Government of Canada is providing $5 billion over 10 years to provinces and territories to support mental health initiatives. 

Background

In Budget 2017, the Government committed to providing HC $29M over 11 years (2017–2028) to establish and implement a new program to support capacity building and adaptation within the health system, better understand and track climate-related health impacts through the establishment of a national monitoring and surveillance program, and support responses to extreme heat emergencies. This will complement Budget 2016 funding to HC of $8.5M over 5 years (2016-2021) to increase the knowledge, capacity, and tools on climate change and health risks, and increase resiliency to extreme heat. An additional $9 million over 5 years (2016-2021) to the Public Health Agency of Canada to enhance the capacity to understand and respond to the increasing distribution of ticks and mosquitoes in Canada as a result of climate change.

Highlights of Health Canada’s work to protect Canadians through efforts to reduce risk from climate change include:
Heat
77% of health regions in Canada have implemented evidence-based adaptation measures to protect health from extreme heat, exceeding the initial target of 50% by 2019. These include establishing heat alert and response systems, providing support to the public during heat waves, such as opening cooling centres, conducting wellness checks with vulnerable people (e.g., seniors, people with chronic illnesses, homeless populations), distributing information on health protective measures (e.g., drinking water, seeking shade).

Health Canada is expanding and improving health promotion activities, such as infographics on risks and how Canadians can protect themselves, as well as an extreme heat video.

Capacity Building
On June 13, 2018, HC launched a $3 million Climate Change and Health Adaptation Capacity Building Contribution program (HealthADAPT). Through HealthADAPT, Health Canada is providing $3 million over three years to support 10 projects at local, regional, and provincial and territorial levels of the Canadian health sector to prepare for, and respond to, the impacts of climate change.
This program supports the human health and well-being objectives of the Pan-Canadian Framework on Clean Growth and Climate Change. The objectives are to: (1) increase understanding of climate change impacts to health and health systems; (2) identify communities or populations that could be more vulnerable; (3) develop, test and implement relevant climate change adaptation plans for regional or other specifications; and (4) monitor and evaluate the effectiveness of adaptation plans.

Health Canada launched the HealthADAPT Community of Practice, a network to support health authorities across the country to learn from one another and share best practices on climate change and health. In January 2020, Health Canada held a national webinar that included 158 participants from health departments across Canada with speakers from the US Centres for Disease Control and Prevention (US CDC) to learn from their climate change program.

Research, Monitoring and Surveillance
Health Canada is increasing understanding of health risks to Canadians from climate change, populations most at risk and the best measures to protect health and prepare Canada’s health systems. The Department is working to support the enhancement and development of the surveillance systems across Canada in an effort to track health impacts of climate change in the health systems. The Department is supporting research efforts to understand the health impacts of extreme temperatures on outdoor workers.
Health Canada is working to establish evidence-based indoor temperature thresholds to protect health of Canadians

To better understand the range of health issues facing Canadians from climate change, Health Canada is conducting a national assessment “Health of Canadians in a Changing Climate: Advancing our Knowledge for Action”, which is currently anticipated to be released in 2021. This builds upon national assessments conducted in 2008 and 2014, and will for the first time feature emerging issues including mental health, impacts on Indigenous populations, impacts on the health system, and health equity.

Personne-Ressource : Carolyn Tateishi, 613-952-8773
Approuvé par : David Morin, 613-946-6700

Opioid Overdose Crisis

Synopsis

• The opioid overdose crisis continues to be a serious and unrelenting public health threat whose effects are being felt by people, families, and communities across Canada. In recent years, Canada has experienced an unprecedented increase in opioid-related overdoses. Between January 2016 and June 2019, there were 13,913 apparent opioid-related deaths across the country. Life expectancy in Canada has stopped increasing for the first time in over four decades; this is largely attributable to the opioid crisis.

Potential question

• How is the Government addressing the opioid overdose crisis in Canada?

Key messages:

• The opioid overdose crisis continues to be one of the most serious and unprecedented public health threats in Canada’s recent history.
• Tragically, between January 2016 and June 2019, 13,913 people across the country lost their lives to apparent opioid-related overdoses. This crisis has devastated families, and communities across Canada.
• Our Government has responded with significant action. We have invested nearly $600M since 2017 to support improved access to treatment and life-saving services; education and awareness among the public and health care providers; research and surveillance to build the evidence base for further action, and have strengthened law enforcement efforts.
• We remain deeply concerned about the opioid overdose crisis in Canada and are committed to a collaborative, compassionate, comprehensive, and evidence-based response. We will continue to work with stakeholders and partners, including provinces and territories, to bring forward solutions to save lives and help reverse this national public health crisis.

If pressed on investments and actions to date

• The investment of nearly $600 million committed by our Government in response to the opioid crisis has focused efforts on prevention, treatment, enforcement and harm reduction. This includes $150 million provided directly to provinces and territories through the Emergency Treatment Fund.
• As part of Budget 2019 and additional funding commitments, our Government committed to investing $106.7M to scale up key life-saving measures, help circumvent the toxic illegal drug supply, and identify and address emerging drug threats.
• Our Government has also made legislative and regulatory changes to encourage people to contact emergency services in the event of an overdose, reduce regulatory barriers to harm reduction services, and make certain medications to treat severe opioid use disorder more accessible.
• However, we know that more needs to be done. We are committed to expand access to drug treatment and address opioid and methamphetamine use disorder, including expanding community-based services, scaling up effective programs, building more in-patient rehab beds, and making drug treatment courts more available.

If pressed on supervised consumption sites

• Evidence clearly shows that supervised consumption services are effective harm reduction measures that help reduce harms and save lives.
• In December 2016, Canada had two operating supervised consumption sites. Since December 2016, the number of operating supervised consumption sites across the country has increased to 40.
• These sites reduce the risk of overdose death and transmission of infections. In addition, they provide access to other health and social services for people who use drugs, including opportunities to pursue treatment.
• Since June 2017, these sites have received over 1 million visits, more than 42,000 referrals to health and social services have been made, and more than 9,000 reported overdoses have been reversed without a single death at a site.
• Given the seriousness of the current opioid crisis, we will continue to take appropriate measures to maintain and expand access to supervised consumption services as part of a public health response to the crisis.

If pressed on treatment for problematic substance use

• The evidence is clear that problematic substance use is a health condition that can be managed and treated.
• Our Government has taken significant steps to improve access to substance use treatment services across the country, including increasing access to medications that can be used to treat severe opioid use disorder, making regulatory changes to reduce barriers to treatment, increasing treatment in federal correctional facilities, and enhancing the delivery of culturally appropriate substance use treatment services in First Nations and Inuit communities.
• Notably, we have invested in an Emergency Treatment Fund, which provided one-time, matched emergency funding totalling $308 million for provinces and territories to improve access to evidence-based treatment services. Provinces and territories are required to report on progress to date, and we are awaiting feedback on how PTs are delivering on their commitments.
• We are committed to continuing to work closely with provinces and territories as well as other partners and stakeholders to address persistent gaps in substance use treatment services across the country.

If pressed on pharmaceutical alternatives to the illegal drug supply ("safer supply")

• The evidence shows that the risk of harm from the use of illegal drugs, particularly those containing opioids, continues to increase. Highly potent synthetic opioids, such as fentanyl and carfentanil have permeated the illegal drug supply, and are fuelling the unprecedented rate of overdoses and deaths.
• Many stakeholders and public health experts have been calling for a secure and predictable supply of pharmaceutical-grade drugs as an alternative to the toxic illegal drug supply, also referred to as “safer supply”.
• Our Government has taken steps towards this objective, including reducing regulatory barriers, funding the development of guidelines for injectable opioid agonist treatment, and supporting safer supply pilot projects.
• Our Government will build on these efforts to expand access to a safer supply of prescription-based opioids by supporting pilot projects and consolidating and sharing best practices. Doing so can help provide pathways to care and treatment.

If pressed on addressing chronic pain

• Chronic pain is a serious health issue impacting one in five Canadians as well as their families and caregivers.
• Our Government recognizes the challenges that Canadians living with pain are facing accessing the health services they need to manage their pain.
• Since 2013, we have invested close to $100 million in pain-related research through the Canadian Institutes of Health Research. This includes $12.5 million for the national Chronic Pain Research Network from 2016 to 2021.
• In addition to these investments, we established the Canadian Pain Task Force to help us better understand and address the needs of people living with pain. We look forward to their June 2020 report which will outline best practices and elements of an improved approach to pain.
• We will continue to take steps to improve health outcomes for Canadians living with pain.

If pressed - decriminalization

• The Government of Canada is not considering the decriminalization or legalization of illegal drugs. We are committed to addressing the opioid crisis, and problematic substance use, from a public health perspective.

If pressed on addressing stigma

• Data suggests that the majority of opioid overdose deaths are occurring when people are alone, often in private residences. A big contributor to this social isolation is the stigma associated with problematic substance use.
• Stigma prevents people who use drugs from receiving supportive health and social services that can help improve wellbeing. This is why stigma has been a big priority for this government.
• Through our national anti-stigma campaign, and outreach with health care professionals and youth, we hope to create a society where people who use drugs can access services without fear of discrimination and prejudice.

Background

On December 11, 2019, jointly with the provinces and territories, the Government of Canada released updated data indicating that 13,913 Canadians lost their lives between January 2016 and June 2019 to apparent opioid-related overdoses. Life expectancy in Canada has stopped increasing, a first in over four decades; this is largely attributable to the opioid crisis.

This most recent national data indicated that, from January to June 2019, 80% of accidental apparent opioid-related deaths involved fentanyl or fentanyl analogues, compared to 54% in 2016. The presence of fentanyl and its analogues in the illegal drug supply is therefore the main driver of recent overdose deaths.

Fentanyl is now so pervasive in the illegal drug market that a large number of Canadians who use drugs are at risk of a potentially fatal overdose. While Canadians of all walks of life are affected, there are striking patterns, with 86% of deaths occurring in BC, Alberta, and Ontario, mostly among young-middle aged men.

Federal actions to address the opioid crisis

The federal government has taken significant actions and made investments of nearly $600M since 2017 to address the opioid overdose crisis and problematic substance use more generally. Action has been taken across the four pillars of the Canadian Drugs and Substances Strategy: Prevention, Harm Reduction, Treatment and Enforcement, underpinned by Data and Evidence. Actions to date include:

• Improved access to treatment and harm reduction, including: $150M Emergency Treatment Fund, reduced regulatory barriers to treatment, more than 40 new supervised consumption sites, and wider availability of naloxone;
• Strengthened law enforcement, including: more than 42kg of fentanyl seized, 6 new detector dog service teams, and more than $37M investment in education and enforcement efforts;
• Developed educational products and tools for the public and health care providers, including: opioid awareness campaign video that has been viewed more than 2.5M times, mandatory opioid warning stickers and patient handouts, new opioid prescribing guidelines, and new restrictions on opioid marketing; and,
• Conducted research and surveillance to build the evidence base, include 15 research grants provided to CIHR, 8 public national reports on opioid-related harms and deaths, 11 Public Health Officers provided to PTs for surveillance efforts, and a new drug checking technology challenge.

Most recently, Budget 2019 and additional funding commitments announced investments of $106.7M over five years with $1M ongoing to: scale up key lifesaving measures ($39.0M), circumvent the toxic illegal drug supply ($35.0M + $1M ongoing), and identify and address emerging drug threats, including methamphetamine ($32.7M).

Chronic pain and the opioid crisis

Chronic pain impacts one in five Canadians. People with chronic pain comprise a significant proportion of people who use drugs (estimates range from 31% to 60%) and those dying of illicit drug/opioid overdose deaths in Canada (19% to 44% dependent on jurisdiction). Unmanaged pain complicates treatment of substance use disorders and vice versa placing Canadians with these concurrent illnesses at risk of negative health outcomes. There is growing consensus of the need to improve health system capacity to address pain and the complexities of concurrent pain, mental health and substance use disorders, particularly in jurisdictions hardest hit by the overdose crisis.

The Government of Canada has heard from stakeholders about the importance of greater national coordination and leadership on pain, and the desire for more robust Government actions to support and improve the quality of life of people who live with chronic pain. To help address these concerns, Health Canada established the Canadian Pain Task Force (3 year mandate) to provide advice regarding best practices and an improved approach to prevent and manage pain in Canada. The Task Force’s first report was published in July 2019. It highlighted weaknesses in our health system to effectively manage pain. It also highlighted innovative clinical models, proven educational approaches, novel support programs, and world-renowned research that exist in pockets across the country. The Task Force’s next report is due in June 2020.

Approved by CSCB ADM: Eric Costen

Vaping-Associated Lung Illness

Synopsis

• Beginning the week of August 19, 2019, news media began reporting on a series of severe lung illnesses in the United States linked to the use of vaping products.
• As of February 18, 2020, the U.S. Centers for Disease Control and Prevention are reporting 2,807 cases of e-cigarette, or vaping product, use-associated lung injury in 50 states, the District of Columbia, and 2 US territories. A total of 68 deaths have now been confirmed in 28 states and the District of Columbia. The US CDC is no longer reporting regularly on E-cigarette or Vaping Associated Lung Injury (EVALI)cases and deaths at the national level.
• The US investigation has found that vitamin E acetate detected in some THC-containing vaping products is strongly linked to the EVALI outbreak. However, the evidence does not rule out the contribution of other chemicals in THC and other vaping products, in some reported cases. This is especially important as more than half of the Canadian cases of VALI have been detected in individuals who self-report vaping nicotine substance exclusively.
• As of March 3, 2020, there are 18 confirmed or probable cases of vaping-associated lung illness reported in Canada. Cases have been reported in six provinces: British Columbia (4), Alberta (1), Ontario (4), Quebec (6), New Brunswick (2), and Newfoundland and Labrador (1).
• Health Canada posted an Information Update for Canadians and updates its vaping-associated lung illness web page on Canada.ca regularly.

Potential question

• What is the Government doing to address vaping-associated lung illness?

Key messages

• Our Government is concerned about the emergence in Canada of vaping-associated lung illness and is committed to protecting health and safety of Canadians.
• We advise Canadians to avoid purchasing vaping products from outside the legal market as these products are unregulated and may pose a greater risk to health and safety.
• Regulatory controls are in place to help safeguard the health of Canadian consumers and to enable Health Canada to respond to emerging health issues in a timely manner.
• We will continue to monitor all available data sources and surveillance systems in Canada to identify incidents of lung illness that could be related to vaping and refer these to the appropriate province or territory for investigation.
• It is also important to remind Canadians that vaping does have health risks. Non-smokers, people who are pregnant and young people should not vape.

If pressed on the process for identifying cases and causes…

• National guidance has been shared by the Public Health Agency of Canada on identifying possible cases of vaping-associated lung illness. Provincial and territorial public health officials are responsible for reporting cases in their jurisdictions.
• A federal, provincial and territorial task group on vaping-associated lung illness has been established to maintain a uniform, national approach to identifying and reporting cases.
• The U.S. Centers for Disease Control and Prevention are reporting findings that show products containing THC play a major role in the outbreak – specifically THC products containing the additive Vitamin E acetate, a substance prohibited in both nicotine and cannabis vaping products in Canada.
• At this time, no specific product, substance or device has been linked to all cases of vaping-associated lung illness in Canada. Health Canada is actively obtaining and testing samples of vaping products.
• We are closely monitoring the situation both at home and in the United States.

If pressed on why canada is regulating access to cannabis vaping products given the link between vaping thc and some vaping-associated lung illness cases in the united states

• Parliament established a deadline of October 17, 2019 for the new cannabis products to be permitted for legal sale.
• Parliament recognized that providing legal access to quality-controlled products can help protect those who choose to consume cannabis from the inherent risks and harms of the illegal market, where there are no standards or oversight for quality control or safety.
• Strict regulations have been put in place to protect consumers. Cannabis vaping products must be produced in licensed facilities that are subject to Health Canada inspections and according to strict requirements.
• Cannabis vaping products cannot contain anything that may cause injury to the health of the consumer. For example, they are not permitted to contain any added colouring agents, mineral nutrients or vitamins, including vitamin E acetate, a chemical of concern in the US cases.
• Licensed processors are responsible for making sure that all their products meet the strict requirements set out in the Cannabis Act and the Cannabis Regulations and do not cause injury to the consumer.

If pressed on the risks of vaping…

• The Government of Canada recognizes that vaping products present their own unique health and safety risks. The potential long-term effects of vaping remain unknown.
• That is why Parliament put in place the Tobacco and Vaping Products Act which aims to prevent uptake by youth and non-smokers. It prohibits the sale of vaping products to persons under 18 and restricts the promotion of vaping products across all media channels, including social media.
• We have also put in place strict regulatory controls to help safeguard the health of Canadian consumers and enable Health Canada to respond to emerging issues in a timely manner.
• My officials are accelerating work on regulatory proposals to address the rise in youth vaping. Regulations on vaping product labelling and packaging were finalized in December. Proposed regulations on vaping product promotion were also published in December. Regulations on nicotine content and flavours will be brought forward in spring 2020.
• Health Canada also has a national public education campaign to inform youth and their parents on the health risks associated with nicotine vaping. The campaign includes advertising and hands-on learning events in schoolsand community settings across Canada. A recent evaluation of the advertising campaign found that 26% of teens who reported having seen the ads decided not to try vaping as a result.

Background

The regulation of vaping products in Canada
Vaping products that contain nicotine are regulated separately from those that contain cannabis. The Tobacco and Vaping Products Act (TVPA), which became law on May 23, 2018, regulates the manufacture, sale, labelling and promotion of both tobacco and vaping products (other than those that contain cannabis).
The manufacture, sale and promotion of vaping products containing certain ingredients such as vitamins and minerals, caffeine and colouring agents are prohibited. Regulatory authorities to further restrict ingredients are also provided for in the Act.
Vaping products regulated under the TVPA are also subject to the Canada Consumer Product Safety Act (CCPSA). That Act prohibits the manufacture, import, advertisement or sale of any consumer product that is a “danger to human health or safety” and requires mandatory incident reporting by manufacturers, importers and sellers of consumer products, and mandatory document retention by any person who manufactures, imports, advertises, sells, or tests a consumer product for commercial purposes.
Both the TVPA and the CCPSA contain regulatory authorities to restrict how vaping products are manufactured (e.g., ingredients) and labelling to protect human health or safety.
The regulation of cannabis vaping products
Vaping products containing cannabis are regulated under the Cannabis Act and its regulations. The Cannabis Act came into force on October 17, 2018, and establishes the framework for controlling the production, sale and possession of cannabis across Canada. Inhalable cannabis extracts, such as vaping products, became legally available for sale in Canada as of October 17, 2019, following the coming into force of amendments to the Cannabis Regulations. The amended Cannabis Regulations establish regulatory controls for legally produced vaping products containing cannabis to help safeguard the health of Canadian consumers and to enable Health Canada to respond to emerging health issues in a timely manner.

Primary Contact: James Van Loon 613-941-1977
Alternate: Dana Beaton 613-941-9826
Approved by: Jacqueline Bogden, ADM, Controlled Substances and Cannabis Branch 613-957-2715

Mental health care availability

Synopsis

• The Government is committed to strengthening access to primary health care, including mental health services.

Potential question

• What is the Government’s plan to enhance access to mental health care for Canadians?

Key messages

• Our Government recognizes the importance of access to mental health services and has made significant investments to this end. Budget 2017 provided provinces and territories with $5 billion over 10 years to improve access to mental health and addiction services for Canadians.
• Budget 2019 provided $25 million over 5 years to implement and sustain a fully operational pan-Canadian suicide prevention service.
• In this new mandate, our Government is committed to doing even more in this area, and we will be working with provinces and territories to support Canadians in getting faster access to the mental health services they need, when they need them.

If pressed on the development of national standards for access to mental health services

• Our government is committed to working with stakeholders, provinces and territories to set national standards for access to mental health and substance use services so Canadians can get fast access to the support they need, when they need it.  

If pressed on correlation between mental health and substance use

• Our government recognizes that too often mental health and substance use issues coexist and is committed to working with stakeholders, provinces and territories to address existing silos so that Canadians can experience comprehensive and integrated services.

If pressed on conversion therapy…

• Our government is committed to amend the Criminal Code to “ban the practice of conversion therapy and take other steps required with the provinces and territories to end conversion therapy in Canada.”
• Health Canada is supporting colleagues in the Department of Justice who have the lead on this important amendment to the Criminal Code.

If pressed on Post-Traumatic Stress Injuries…

• Our Government recognizes the impact that posttraumatic stress disorder, also known as PTSD, has on individuals, families, communities and workplaces.
• Our Government recognizes the tremendous impact that post-traumatic stress disorder, also known as PTSD, has on individuals, families, communities and workplaces.
• On January 22, 2020, the first Federal Framework on PTSD, developed in collaboration with partners was tabled in Parliament.

If pressed on suicide prevention…

• The Government recognizes the impact suicide has on families and communities.
• Budget 2019 announced $25 million over 5 years to implement and sustain a fully operational pan-Canadian suicide prevention service.

If pressed on other investments in mental health…

• Our Government cares deeply about the mental health of Canadians and recognizes the importance of intervening early to promote mental health and prevent mental illness.
• That is why we are investing in programs that promote mental health, build resilience in vulnerable young children and families, and prevent mental illness and suicide.

If pressed on international engagement…

• Our Government is working to advance mental health on the global stage.
• Canada’s engagement with our global partners on mental health allows us to share Canada’s best practices and learn from others as we seek to address mental health challenges affecting many Canadians.
• In May 2018, Canada co-founded, alongside the United Kingdom and Australia, the Alliance of Champions for Mental Health and Well-Being.
• Ministers joining the alliance commit to advancing global mental health through collective international action.

Background

One in three Canadians will be affected by a mental illness in their lifetime, and the economic, social and human costs are high. The total cost of mental illness to the Canadian economy has been estimated at $50B each year, in direct and indirect costs, equivalent to 2.8% of GDP.

Systemic Access Barriers

The availability of mental health care services in Canada is limited. According to Statistics Canada, in 2018, 17.8% of Canadians aged 12 and older (roughly 5.3 million people) reported having needed some help with their mental health in the previous year. Among those 5.3 million Canadians, 43.8% reported that their needs were either unmet or only partially met. Access to mental health care services for children and youth is of particular concern, given that most (75%) of mental disorders have their first onset before the age of 25.

Provincial/Territorial and Federal Roles in Mental Health

While PT governments have primary jurisdiction in the planning and delivery of mental health services, the Government of Canada also plays a vital role, including funding mental health research and promotion, mental illness surveillance and suicide prevention. It is also responsible for the delivery of mental health and addictions services to several federal populations, including First Nations on-reserve and Inuit, federal inmates, veterans and military personnel.

In 2007, the Government of Canada established the Mental Health Commission of Canada (MHCC) as an arm’s length organization to act as a catalyst for fostering improvements in the mental health care system. The MHCC is currently helping the Government advance mental health work in problematic substance use, suicide prevention, and target initiatives for vulnerable populations. Budget 2018 confirmed an investment of $10 million over five years for MHCC to help assess the impact of cannabis use on the mental health of Canadians.

Government Commitments

Funding to Provincial and Territorial Governments
The Government of Canada is investing $5 billion over ten years to improve Canadians’ access to mental health services. The investment is being provided directly to provinces and territories to help them expand access to community-based mental health and addiction services for children and youth, integrated services for people with complex needs, and spread proven models of community mental health care and culturally appropriate interventions linked to primary health services. In August 2017, an agreement was reached with the provinces and territories on a Common Statement of Principles for Shared Health Priorities (CSOP)that confirmed these priorities. Bilateral agreements have since been finalized with each jurisdiction that set out details of how they will use federal funding in future years, consistent with the CSOP.

Mental Health Promotion Innovation Fund
Through the Public Health Agency of Canada’s (PHAC) Mental Health Promotion Innovation Fund, the Government of Canadais investing $39 million from 2019-2028 to address multiple risk and protective factors to promote mental health for children, youth, young adults and populations susceptible to mental health inequities (e.g., low-income families, immigrants and refugees, First Nations, Inuit, Métis, LGBTQ2+, people living with disabilities and people with other socio-economic risk factors).

Suicide Prevention
The Government of Canadahas provided funding to Crisis Services Canada in the amount of $4.3 million over five years to support the development of the Canada Suicide Prevention Service (CSPS). Budget 2019 announced an additional $25 million over five years and $5 million ongoing to augment and sustain this service, with PHAC launching a call for proposals on July 8, 2019 for organizations interested in leading the CSPS. The Federal Framework for Suicide Prevention was made publicly available in November 2016. It focuses on raising public awareness, reducing stigma, disseminating information and data, and promoting the use of research and evidence-based practices. Progress Reports on the Framework are available on Canada.ca, with the next report planned for release in December 2020.

Post-Traumatic Stress Disorder
The Federal Framework on Post-Traumatic Stress Disorder Act received Royal Assent in June 2018. The Act requires the development of a comprehensive federal framework on Post-Traumatic Stress Disorder (PTSD), to be tabled in Parliament by December 21, 2019 and published on Canada.ca within 30 days of tabling. To inform the development of the federal framework, in accordance with the Act, the Minister of Health convened a National Conference on PTSD in April 2019 with the Ministers of National Defence, Veterans Affairs, and Public Safety and Emergency Preparedness Canada, partners and stakeholders, including people with lived-experience.

Conversion Therapy

The Department of Justice is leading the file on banning conversion therapy. Health Canada has supported the Department of Justice by reviewing definitions, providing journal articles and conducting an environmental scan on conversion therapy.

The Government of Canada has committed to amend the Criminal Code to “ban the practice of conversion therapy and take other steps required with the provinces and territories to end conversion therapy in Canada.”

“Conversion therapy is a practice that aims to change an individual's sexual orientation to heterosexual or gender identity to cisgender, which means identifying with the sex assigned to them at birth.” Conversion therapy consists of efforts such as counseling, religious practices, behavioral modification, cognitive reframing, and other means to attempt to change an individual’s sexual orientation. Conversion can result in negative outcomes such as distress, anxiety, depression, negative self-image, a feeling of personal failure, difficulty sustaining relationships, and sexual dysfunction.

There are differences across provincial legislation where Manitoba, Ontario and Nova Scotia have current legislation against the practice of conversion therapy. New Brunswick and Prince Edward Island have proposed motions to ban conversion therapy. Other provinces have no legislation in place, but have expressed support for a conversion therapy ban.

HC contact: Cindy Moriarty 613-946-9375
Approved by: Kendal Weber

Women’s sexual and reproductive health rights

If pressed…

• In July 2019, the Government of Canada released its five-year Action Plan on Sexually Transmitted Blood-borne Infections or STBBI which outlines a renewed and expanded collaborative approach to implementing the STBBI Framework for Action within the federal mandate.
• We are investing more than $88.5 million this year in STBBI research, prevention, diagnostic technology and support for communities through our HIV and Hepatitis C Community Action Fund and our Harm Reduction Fund.
• In addition, we are working with provinces and territories experiencing infectious syphilis outbreaks.

Dental care

Synopsis

• The Speech from the Throne and the mandate letter for the Minister of Health committed the Government to work with Parliament to study the possibility of national dental care.

Potential question

• What is the Government of Canada doing to address the unmet dental care needs of Canadians?

Key messages

• The Government of Canada is committed to working collaboratively with the provinces and territories to strengthen health care.
• Canadians have coverage for dental care through employee health benefit plans and through federal, provincial, and territorial dental programs.
• But we know there remain unmet needs for dental care in Canada. That is why we welcome the Standing Committee on Health’s decision to study the issue of dental care in Canada.
• My mandate letter includes a commitment to support Parliament in this work, which I am pleased to do, so that we can better understand what the Government’s role may be in helping to improve access to dental care in Canada.
• Dental care is only one aspect of improving the health care of Canadians. Our Government is also committed to improving access to primary care, mental health services, home and palliative care, and implementing national universal pharmacare for Canadians.

Background

• In the December 5 Speech from the Throne and in the Minister of Health’s mandate letter, the Government committed to exploring national dental care.

Dental Care in Canada

• According to the Canadian Institute for Health Information, $15.5 billion was spent on dental services in 2017: 54% was covered through private insurance ($8.4 billion); 40% was paid out-of-pocket ($6.2 billion); and 6% was publicly funded ($933 million).
• The majority of Canadians receive dental coverage through employment-based private health insurance plans, which cover about two-thirds of Canadians.
• Good data does not exist on unmet dental care needs at a national level in Canada. A group of non-government health organizations, led by the Canadian Association of Public Health Dentistry, is coordinating an email campaign seeking input from health professionals on the Government’s commitment to support Parliamentary study of national dental care. The campaign suggests that 1 in 5 people (6 million Canadians) are not receiving needed dental care due to cost, and that only Canadians with financial resources or dental insurance can experience good oral health.
• The federal government provides recognized First Nations and Inuit with dental coverage for services not available under other federal, provincial, or territorial programs. The federal government also provides dental services to Canadian Armed Forces personnel and inmates in federal penitentiaries, and provides dental coverage for some veterans and refugee claimants.
• The federal government further supports Canadians with private health insurance by not including the value of these insurance plans in the taxable income of employees. In addition, the income tax system provides assistance through the Medical Expenses Tax Credit, and through a refundable medical expenses supplement available for working individuals with low incomes and high medical expenses.
• PTs provide emergency, in-hospital medically necessary dental care for all residents. Additional PT programs vary in eligibility and coverage, and are limited to select services for groups such as low-income groups, people with disabilities, children and seniors.
• The Canada Health Transfer is providing $40.4 billion to the provinces and territories in 2019-20. PTs can use these federal funds to support their dental programs, along with their other health services.

New Democratic Party’s dental care proposal

• During the election campaign, the New Democratic Party (NDP) identified inequality and wasted spending related to dental care access as a priority, arguing that care avoidance due to cost results in preventable oral health emergency room spending. The NDP committed to address this issue through a national, income-based “Denticare” plan that would be available in 2020. Most dental care would be free for households earning under $70,000 annually, with a sliding co-payment scale for those earning between $70,000 and $90,000. No mention is made of households earning above $90,000 annually.
• The NDP proposed that dental care would be added to the Canada Health Act, and that the program would be administered by the federal government, or by PTs upon agreement (in combination with existing PT dental programs). Denticare coverage would be similar to the federal government’s Non-Insured Health Benefits (NIHB) program for First Nations and Inuit persons. The NDP considers its proposal “a down payment” on the goal of having all dental care included in Canada's publicly funded health care system.
• The Parliamentary Budget Officer (PBO) costed the plan and said Denticare would cost nearly $1.9 billion for 2020-2021, and drop to $824 million in 2021-2022, with costs remaining relatively stable at $856 million by 2028-2029.

Contact: Gavin Brown (613-957-8994)
Approved by: Kendal Weber (613-946-1791)