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Where We're Going

 Changing World    |   Impacts on health

Strategic Context

Given the range of issues that affect the health of Canadians, the Agency’s activities must respond to broad domestic and global trends, to government priorities and constraints and to specific health challenges. These complex influences must be managed to meet our objectives of enhancing the health of Canadians, reducing health disparities and strengthening public health capacity.

Our Changing World

The Changing Face of Canada

As noted in the 2006 Census, Canada has the highest rate of population growth in the G8, with the majority of this growth coming from immigration. Most immigrants settle in major centres, in particular in Montreal, Toronto and Vancouver, and, together with the continuing out-migration from rural areas, form part of the increasing urbanization and suburbanization of our country. While these population shifts have created key centres for economic growth in Canada, they have also led to greater concentrations of poverty in some neighbourhoods, threatening the health and well-being of many of our children and youth. Urbanization has also brought problems of crime, transportation, air quality and infrastructure gaps for our major cities. By contrast, rural regions face fewer economic opportunities, a reduced working-age population and growing gaps in services, all of which are also having significant health impacts.

At the same time, due to a combination of low birth rates and longer life spans, the aging of Canada’s population continues to increase. In the next 10 years, Canadians over age 65 will outnumber those under age 15, while the “oldest old” (those aged 80 and over) will become a significant demographic group. While forcing a renewed societal emphasis on seniors’ social engagement and independence, these changes will also have impacts in the incidence and distribution of many diseases and injuries, and will place increasing pressures on Canada’s health system.

The exception to these demographic changes has been Canada’s Aboriginal peoples. While the majority of this population lives in urban settings, over a third still resides in isolated, poorly serviced communities with few economic opportunities. And while the Aboriginal population is younger and faster growing than the rest of the Canadian population, it also faces a number of specific health problems. Strengthening relationships with and improving the quality of life of Aboriginal populations, both on and off reserve, are key challenges for the federal government, given its special role in this area. For PHAC, there is a need to clarify our role in relation to Aboriginal public health and to place increased emphasis on Aboriginal public health considerations, through the development of an Aboriginal public health policy framework.

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Environment

Canadians are increasingly recognizing the linkages between health and the environment, not only in areas like the effects of toxins and pollutants, but also in the impacts of climate change and the trade-offs involved in sustainable development. Growing populations are placing an increased pressure on the environment globally while, in Canada, greater urbanization brings with it increased demands for energy, land and other resources, as well as increased concentrations of toxins and pollutants. A strong and comprehensive public health policy is needed to identify and address linkages between health and the environment and to assist affected communities.

Brian Coombes is a scientist in PHAC’s Laboratory for Foodborne Zoonoses, trying to find new ways to prevent infections that are passed from animals to humans. Brian won a prestigious international award from the American Society for Microbiology, which rewards early career scientists for research excellence and potential in microbiology and infectious diseases.

Science and Technology

The rate of scientific discovery and technological innovation has increased dramatically in the past decade, but the impact on the health sector has been mixed. On the one hand, advances in treatment and care can offer new opportunities to address illness and improve health. On the other hand, these advances have placed increased cost pressures on our already stressed health system. However, by providing new approaches for improving health and preventing disease, in part through a better understanding of the determinants of health and the impact of health promotion policy and community interventions at the national and international levels, advances in public health can help mitigate these costs. As well, there have been rapid advances in public health genomics – an emerging field that assesses the impact of the interaction between genes and the environment (i.e., physical environment, diet, behaviour, drugs, and agents of infectious diseases) on population health. The idea is that the knowledge from advances in biotechnology and genome-based research can be applied to prevent disease and improve the health of populations. The Agency will therefore continue to form collaborative partnerships with national and international science and policy communities to translate rapidly evolving knowledge to improve health and reduce the impact of both chronic and infectious diseases.

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Globalization and Global Public Health

Societies and economies are becoming increasingly interdependent. These interactions are propelling capital, labour, resources, goods, services, technology, ideas and culture around the world. The impacts and opportunities are staggering. Globalization has already had a profound impact on public health in Canada. The vast increase in the volume and speed of trade and travel has brought significant economic benefits to Canadians, while making available a greater range of consumer products and foods. But there are challenges as well. Over the past 30 years, health in Canada and in other migrant-receiving nations has been increasingly influenced by human migration. Migration represents one way in which globalization has meant a greater risk from infectious disease, increasing both the likelihood of an outbreak and the speed of its transmission. Keeping pace with the demands of a global economy has meant greater time pressures for Canadian families, along with a proliferation of convenience foods and reduced time for physical activity. As well, globalization has had a major effect in the area of health security, as the free movement of people and ideas has also facilitated the export of instability and violence, bringing threats to the health and safety of Canadians. And while the risk of a health emergency remains low, the impact of an event, whether natural or man-made, could be catastrophic.

A strong international public health infrastructure and better global health are in Canada’s interest: by reducing the risk of illness elsewhere, we help protect Canadians against current and emerging public health threats. As well, through our participation in treaties and agreements such as the International Health Regulations, Canada has specific obligations to meet within the international community. By sharing Canadian expertise and taking a leadership role on behalf of Canada in international fora, the Agency can help achieve these goals, in partnership with foreign governments and international organizations. And as the Government of Canada’s central coordinating point for health security issues, PHAC will continue to build Canada’s capacity for a robust and comprehensive national response in the event of public health emergencies, in collaboration with other federal departments, other levels of governments and stakeholders.

In June 2005, PHAC's National Microbiology Laboratory in Winnipeg dispatched one of its highly specialized mobile lab units (shown above) to northern Angola, Africa to monitor an outbreak of Marburg virus, a viral haemorrhagic fever disease similar to Ebola. PHAC has been recognized worldwide for its field diagnostic development of vaccines for Ebola and Marburg viruses.

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Evolving Values and Governance

Canadian values reflect our increasingly urban and suburban experience, maintaining a high priority for equity and fairness while placing an increasing emphasis on acceptance and diversity. Our health system remains a high profile issue, both as a reflection of Canadian values and as a contribution to Canadians’ sense of national identity. Not only is there a growing awareness of public health as a key component within this system, but also an expectation on the part of Canadians that public health will be there to protect their well-being. As well, although the level of formal participation in the political process has declined (i.e., voting or party membership), there have been increasing demands for engagement in decision-making and priority setting. Canadians also insist on honesty, transparency and accountability from governments. The Agency will seek to respond to these demands with continued public consultation and engagement in the development of public health strategies.

Thomas Kind is a Quarantine Officer Supervisor at the Vancouver Quarantine Station. He and his team prevent the introduction and spread of communicable diseases into Canada. They monitor health events around the world, respond to reports of ill travellers, and work closely with port authorities and conveyance operators.

The Government Context for Public Health

In its strategic planning, the Agency must respond not only to changes in the external environment, but also to priorities, opportunities and constraints within the government context.

One key factor in this setting is that the Government of Canada has identified government accountability as a key priority. The Agency values management excellence with regard to public resources, and has received recognition for its consistent oversight of its grants and contributions programs. Under the new Federal Accountability Act, the Government is strengthening oversight and management to ensure transparency and accountability to Canadians, with a focus on appointments, contracts and auditing within government departments and Crown corporations. The Agency will continue to emphasize the transparency and accountability of its operations, and will ensure that its programs continue to meet government requirements as these evolve.

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Intergovernmental Relations

Another key element in the Agency’s context is its relationships with other actors. Progress on public health issues requires close collaboration across governments, including other federal departments and agencies, provincial and territorial public health authorities, and local/municipal/regional governments. While health care is primarily a provincial and territorial responsibility, public health is shared across jurisdictions, and the Agency provides leadership on key federal/provincial/territorial processes such as the development of The Canadian Pandemic Influenza Plan. The Agency therefore will continue to work with provincial and territorial governments through the Public Health Network2 and the Council of Chief Medical Officers of Health to address public health issues of national importance, while strengthening its collaboration with federal entities (e.g., Health Canada, Environment Canada, the Canadian Food Inspection Agency) that have a key role in addressing public health issues. As the key federal organization responsible for public health issues, the Agency has a clear leadership role to play in developing and coordinating efforts to meet these challenges.

Public Health Capacity

In this context, one of the most significant challenges facing all governments is the traditionally weak and limited public health capacity in Canada. Gaps in this capacity have been identified by all governments, and were highlighted by the events of the SARS outbreak of 2003. Although improvements have been made since that time, there remains a lack of qualified public health professionals across Canada, gaps in systems for communications and information-sharing, and uneven resources and capacity across jurisdictions. The Agency is working in partnership with stakeholders and other governments to develop strategies that will address these gaps in capacity, which limit our ability to take action on major health issues.

Biologist Jay Krishnan is working in a class 3 cabinet at the National Microbiology Laboratory in Winnipeg. Class 3 cabinets protect laboratory personnel by containing all hazardous material in a totally enclosed, ventilated cabinet.

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Impacts on Health

Determinants of Health / Health Disparities

As we know, although the overall health of Canadians is excellent, some are being left behind. Because health is determined by interactions between genetic endowments, social and economic factors, the physical environment and individual behaviours, a number of the trends identified above have major health impacts. Urban Canadians living in poorer neighbourhoods, new immigrants cut off from their usual social supports, rural Canadians facing the collapse of local economies, or Aboriginal Canadians lacking a sense of control over their future – all are at risk of worse health. Public health has a key role to play in mobilizing efforts across sectors in order to address these determinants of health. With this in mind, the Agency will continue to place a high priority on action on health disparities, in collaboration with other governments, sectors and partners.

Dr. Robert Geneau is a Research Scientist at the World Health Organization Collaborating Centre on Chronic Disease Policy within PHAC. Dr. Geneau's expertise in qualitative research and in-depth understanding of public policy development benefits PHAC's Policy Observatory on Non-Communicable Diseases (NCD). He Holds a Master's degree in Social Sciences, a PhD in Public Health, as well as postdoctoral training in Knowledge Transfer and Exchange.

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Chronic Disease and Injury

Chronic diseases such as diabetes, heart disease, stroke and cancer account for the majority of deaths and disease in Canada. The burden will continue to grow as our population ages. Many of the underlying causes and risk factors are the same for a number of these diseases. Risk factors such as exposure to environmental toxins and pollutants, unhealthy eating and physical inactivity are becoming more prevalent. As reflected in media coverage and public concerns, Canadians have an increasing awareness of these risks, as well as a growing recognition of the burden and costs of mental illness in Canada. Injuries are a leading cause of death in Canada for people ages 1 to 44, and injury prevention programs are crucial to reducing injury rates in Canada. The Agency will continue to seek integrated approaches to injury prevention, as well as the treatment and prevention of chronic diseases, and will work with partners to develop collaborative methods to address associated risk factors.

Infectious Disease

Although infectious diseases are not among the top causes of death in Canada, the impact of an uncontrolled outbreak of any infectious disease would be immense. As we saw with SARS, even the perception that an infectious disease is out of control can cause major social and economic dislocations. The effects of globalization mean that an outbreak anywhere in the world can swiftly appear in Canada, while climate change and the growing global population increase the risk of a new disease emerging. In addition, several emerging or rare diseases have appeared or reappeared in the world in recent years, including West Nile virus and Lyme disease. To address these risks, the Agency will continue to develop and implement preparedness and disease prevention strategies, while taking a leadership role on infectious disease prevention through participation in national and international organizations and scientific efforts.

Dr. Darwyn Kobasa is a research scientist at the National Microbiology Laboratory, working on a technique known as reverse-genetics. This new area of research is having a significant impact on public health and could help our ability to respond to an influenza pandemic. In 2006, Dr. Kobasa received PHAC’s Most Promising Scientist Merit Award.

2 The Public Health Network is a mechanism for intergovernmental collaboration and coordination on public health issues -- while respecting jurisdictional responsibilities in public health. It is mandated to develop and implement collaborative Pan-Canadian approaches to public health issues and challenges, and to provide policy advice to the Conference of Federal/Provincial/Territorial Deputy Ministers of Health on public health matters. Through the Public Health Network, new partners are able to share knowledge and expertise, collaborate on shared priorities and strengthen the capacity of the public health system.

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