The Chief Public Health Officer's Report on The State of Public Health in Canada 2008

What is being done

Governments, the private sector, not-for-profit organizations, communities and individuals are undertaking initiatives across the country to close the gap on health and social inequalities. The successful Canadian initiatives listed below are examples of promising models for future consideration:

Focus on Poverty

• Saskatchewan introduced an initiative in 1997 comprised of employment supplements, child benefits, and family health benefits that have helped low-income people achieve financial security. Since 2004, the province has seen 41% fewer families dependent on social assistance (6,800 families and almost 15,000 children) and a substantial increase in after-tax disposable income among families working for minimum wage. 

• Quebec's Family Policy, introduced in 1997,includes an integrated child allowance, enhanced maternity and parental leave, extended benefits for self-employed women, and subsidized early childhood education and childcare services. Over the last 10 years, Quebec has experienced a steady decline in its poverty rate that has resulted in the greatest overall decrease among provinces.  Economic growth and government programming are reported to have contributed to this decline.

Education

• Regent Park Community Health Centre's (Toronto) Pathways to Education program provides academic, social, financial and advocacy supports to at-risk and economically disadvantaged youth. The program has dramatically decreased dropout and absenteeism rates, quadrupled the number of young people from the community attending college or university, and reduced teen pregnancy rates by 75%. The Pathways to Education program is now expanding to five other cities with plans to reach 20 communities across Canada.

Food Security / Nutrition

• Breakfast for Learning provides funding, nutrition education and other resources to community based student nutrition programs across the country. Since 1992, the program has served healthy breakfasts, lunches and snacks to over 1.5 million Canadian school children.

• Food Banks In 2006, the Canadian Association of Food Banks (CAFB) moved over 8.5 million pounds of food-industry donations (worth $18 million) to its members through the National Food Sharing System. In addition to food received from the CAFB, community run food banks collect and distribute an estimated 150 million pounds of food per year.

• Canada Prenatal Nutrition Program (CPNP) provides long-term funding to community groups to develop or enhance programs for at-risk pregnant women and their children. The CPNP program participants were found to have higher birth weights with increased program participation and higher breastfeeding rates than the general population.

Building healthier communities

• The Vancouver Agreement between the governments of Canada, British Columbia and Vancouver opened new health clinics in the downtown east side of Vancouver, expanded addiction treatment services, and services for at-risk youth and sex-trade workers. Results: reduced death rates from risky behaviours as well as greater access to health services.

• Habitat for Humanity Canada provides low-income Canadian families with safe, affordable housing. Since 1985, the organization has built more than 1,200 homes across the country that have resulted in less reliance on social services and improved health for these families.

• Healthy Cities initiative aims to encourage communities to create age-friendly physical and social urban environments that will better support older citizens in making choices that enhance their health and well-being and that will allow them to participate in their communities, contributing their skills, knowledge and experience.

Early childhood development

• The Community Action Program for Children (CAPC) provides long-term funding to community groups and coalitions offering programs to address the health and development of children (aged 0 to 6 years) who are living in conditions of risk (e.g., low income, single parents, newcomers to Canada). Results include lower rates of maternal depression and sense of isolation, and fewer emotional and behavioural issues reported among children.

• Canada's Aboriginal Head Start in Urban and Northern Communities and Aboriginal Head Start On Reserve programs for preschoolers, parents and caregivers provides an opportunity for children to learn traditional languages, culture and values, along with school readiness skills and healthy living habits. A recent evaluation of Aboriginal Head Start in Urban and Northern Communities reported significant gains in children's physical, personal and social development and health, among other benefits.

• Healthy Child Manitoba promotes and supports community based programs that reflect each community's diversity and unique needs. Results from program specific evaluations have ranged from improved parenting skills to an 80% enrolment rate in the STOP FAS program ― an alcohol and drug treatment program for women who have used alcohol or drugs during current or previous pregnancies.

Improving access to health care

• Toronto's Mobile HealthUnit, part of the Immigrant Women's Health Centre, provides women in factories, shelters, community centres and other locations with the opportunity to receive free primary care from female health-care providers experienced in cultural and gender sensitivity and the challenges facing immigrant women. Employers at work sites visited by the unit report experiencing lower employee absenteeism caused by health issues and off-site medical appointments.

• TeleHomeCare in Prince Eward Island enables nurses in the West Prince health region to monitor patients with complex health needs who are living at home. Since launching the service, the health region has seen a 73% reduction in days of hospitalization, 15% fewer emergency room visits, 46% fewer hospital admissions and a 20% drop in doctor's office appointments among clients.

• Nova Scotia's Eskasoni Primary Care Project built a new health centre for a Mi'kmaq community on Cape Breton Island. Annual visits to the family doctor are down from a high of 11 visits per year to approximately 4; trips to the outpatient/emergency department at the regional hospital are down 40% and medical transportation costs were reduced by $200,000 in the three-year period after the centre was opened.  In 2004, the five Cape Breton Bands came together through the Tui'kn Initiative to build upon and expand the model to all Cape Breton First Nations communities.

Social support and connectedness

• No Smoking A hundred years ago, it was believed that tobacco was beneficial and its use was encouraged.  By 1965, more than 50% of the Canadian population over 15 smoked.  As smoking rates continued to rise, research uncovered the truth - tobacco use is an addiction that harms the health of the smoker and those exposed to second-hand smoke. Once these dangers were understood, Canada began to take action through tobacco control strategies involving education and promotion, taxation, introduction of smoking by-laws and cessation support. Today, only 19% of the Canadian population smokes.

  Montreal's Santropol Roulant forges unique connections, providing inexpensive, nutritious meals and friendship to seniors and other vulnerable people, and meaningful work experience to unemployed youth. Given the soaring costs of hospitalization to treat a malnourished patient, the potential savings to taxpayers from this service is estimated at $2.4 million over the last five years. 

Encouraging healthy lifestyles

• ActNow BC champions programs and initiatives that encourage healthy behaviours. To date, more than 130 towns, cities and First Nations communities have registered as “Active Communities,” 100% of school districts have additional physical activity throughout the school day, and the BC Ministry of Health has piloted a Workplace Wellness initiative that extends the approach to workplaces across the province.

What more can we do: Priority areas for action

Evidence indicates that the following priority areas can make a difference in reducing health inequalities:

• Social investments, particularly investments in families with children living in poverty and in early child development programs.
• Community capacity through direct involvement in solutions, enhanced co-operation among different sectors, better defined stakeholder roles and increased measuring of outcomes.
• Inter-sectoral action through integrated, coherent policies and joint actions among parties within and outside the formal health sector at all levels.
• Knowledge development through a better understanding of different groups of Canadians, how socio-economic factors interact to create health inequalities, how best practices from other jurisdictions can be adapted to improve our efforts, and through more advanced measurement of the outcomes of the various interventions undertaken.
• Leadership at the public health, health and cross-sectoral levels.

Moving Forward

Conditions are ripe for Canadians to aim to be the healthiest nation with the smallest gap in health between the most and least advantaged individuals.

Greater health equality is possible

The Role of the Chief Public Health Officer of Canada

The position of Canada's Chief Public Health Officer (CPHO) was created in 2004, along with the Public Health Agency of Canada, to guide the Government of Canada's efforts in public health. These actions were taken, in part, in response to the SARS (Severe Acute Respiratory Syndrome) outbreak of 2003.

Heading the Public Health Agency of Canada (PHAC), the CPHO is responsible for both advising the Minister of Health on matters of public health and for overseeing the day-to-day functions of the Agency. As Canada's lead public health professional, the CPHO is also required to report on an annual basis on the state of public health in Canada.

At the same time, the CPHO may communicate directly with Canadians and governments on important public health matters. One means of doing this is through his annual Report on the State of Public Health in Canada.

Find out more

View the full Chief Public Health Officer's Report on the State of Public Health in Canada 2008.

Learn more about public health and the work of the Public Health Agency of Canada.