Background
D Wigle

Health Canada has been restructured over the past few years as a result of reviews of the federal government's programs as well as ongoing and extensive reviews of the Department's programs. As part of this review process, Health Canada proposed to invest in strengthening "population health intelligence" activities at the Laboratory Centre for Disease Control (LCDC). This was endorsed by the federal, provincial and territorial health ministers in 1994 and was implemented in April 1995.

The use of the term "health intelligence" was an attempt to describe the synthesis of information from surveillance,1 fundamental research and intervention research and its use for health planning and policy development. The strengthening of LCDC's health intelligence program was designed to address priority areas including bloodborne pathogens, hospital infections, sexually transmitted diseases, respiratory and enteric infections, cancer, reproductive and child health, cardiovascular disease and injuries.

In the chronic disease area, this decision ultimately led to the splitting of the former Bureau of Chronic Disease Epidemiology into three new groups: the Bureau of Reproductive and Child Health, the Bureau of Cardiorespiratory Diseases and Diabetes and the Cancer Bureau. The new "chronic" bureaux were established in September 1995.

In reorganizing the former Bureau of Chronic Disease Epidemiology, it was decided to transfer the production of Chronic Diseases in Canada (CDIC) and its sister publication, Canada Communicable Diseases Report (CCDR), to LCDC's new Document Dissemination Division. Lori Anderson, the Editor-in-Chief, and Irene Kodak, the Publications Clerk, will continue producing CDIC in their new positions in the Document Dissemination Division. Dr Christina Mills, Chief of Prevention in the new Cancer Bureau, remains as CDIC's Scientific Editor and will continue to work closely with Lori and Irene.

1 The ongoing monitoring, analysis, interpretation and dissemination of information on diseases and other health issues.

I would like to tell you a bit more about the Cancer Bureau. The importance of cancer is underlined by facts such as these: in 1996, there will be 129,000 new cancer cases in Canada and 62,000 deaths; 35% of Canadian females and 40% of males will develop cancer; only half of the persons who develop cancer survive for at least five years; cancer is the leading cause of premature death as measured by potential years of life lost before age 75; the annual numbers of cancer cases and deaths will double by about the year 2010.

The Cancer Bureau's four divisions (and their chiefs) are Prevention (Dr Christina Mills), Behavioural Risk Assessment (Dr Howard Morrison), Environmental Risk Assessment and Case Surveillance (Dr Yang Mao) and Early Detection and Treatment (Dr Isra Levy, a consultant, is performing the duties of Chief at present).

The goals of the Cancer Bureau are outlined below.

• Identify populations at high risk of developing or dying from cancer (including clusters) to target interventions and to guide risk assessment investigations

• Assess the impact of cancer on Canadians and measure trends

• Assess determinants of cancer incidence, morbidity (including quality of life) and mortality

• Demonstrate needs for intervention programs and resources

• Develop hypotheses leading to analytic investigations about risk factors for cancer incidence and progression

• Conduct knowledge synthesis and promote consensus building for the planning of cancer prevention and control programs and policies

Bureau of Reproductive and Child Health
C McCourt

In the new Bureau of Reproductive and Child Health, we are fortunate to have as our foundation the excellent work of Dr Don Wigle and Dr Greg Sherman from the former Bureau of Chronic Disease Epidemiology.

The core activity of the new bureau is national surveillance of selected child health issues. The issues are chosen based on health impact, national surveillance needs, the priorities of Health Canada, the level of resources available and the need to complement the child health programs of the other bureaux in LCDC. Our current issues are reproductive, perinatal and infant health, and child injury (including maltreatment).

The Bureau of Reproductive and Child Health uses a conceptual framework that describes surveillance as a cycle of data collection, analysis and response. Our response activities include information dissemination, policy development, prevention/intervention programs and targeted epidemiologic risk assessment studies. As with all of LCDC, our surveillance is done in partnership with many stakeholders-government agencies, non-governmental organizations, academic centres and international agencies.

I hope that, over the next years, the Bureau of Reproductive and Child Health will build strong communications with the readers of CDIC.

Bureau of Cardiorespiratory Diseases and Diabetes
F Li

The ultimate goal of the Bureau of Cardiorespiratory Diseases and Diabetes is to reduce mortality, morbidity and disability due to cardiovascular disease, chronic respiratory disease and diabetes in Canada. We plan to achieve this goal through our core functions of national surveillance, disease prevention and control, and risk assessment.

Surveillance has been acknowledged as the "foundation stone" of public health-it monitors the health status of the population; identifies health problems, needs and priorities; enables evidence-based decisions on health programs and policies; and monitors progress of intervention programs. The Bureau of Cardiorespiratory Diseases and Diabetes is committed to performing the various surveillance activities at the national level. The Bureau also co-ordinates cardiorespiratory diseases and diabetes (CRDD) surveillance activities across various jurisdictions and provides surveillance assistance as needed to public health partners.

Since the provision of health services is largely the responsibility of the provinces, the Bureau will not be providing direct public health services to the population. However, it does have the unique role of providing national leadership, co-ordination and facilitation of CRDD prevention and control programs in Canada. Many organizations, including governments, voluntary agencies and professional organizations, have undoubtedly been undertaking valuable initiatives in this area. We believe, however, that a co-ordinated and concerted effort among various public health partners with common goals and strategies will add to the effectiveness and efficiency of CRDD prevention and control in Canada. Also, we hope that the "facilitation" activities of the Bureau-such as consensus building, knowledge synthesis and transfer, training and information sharing, and provision of technical and program assistance-will assist in addressing the disparity in the quality and quantity of CRDD prevention and control among various jurisdictions.

Although risk assessment, or the conduct of etiologic epidemiologic study, will not be a major component of our bureau's work, we will carry out such projects if they are deemed essential for national CRDD prevention and control.

Performance of the above functions requires regular communication and close co-ordination and collaboration with all our public health partners, and we are committed to establishing and maintaining these important links. In the future, our bureau will regularly publish relevant CRDD surveillance and prevention and control information through Chronic Diseases in Canada. In the meantime, we are also actively exploring mechanisms for facilitating access to surveillance data and scientific information, exchange of program information, discussion of issues and ideas, and other similar activities through the electronic superhighway (Internet, BBS).

To allow us to better serve you and respond to your CRDD program needs, we will strive to make ourselves as relevant to your daily public health work as possible. I am looking forward to our future collaboration and partnership.

If you have comments and suggestions relating to the directions and activities of any of the three new "chronic" bureaux at LCDC, we invite you to send them to the attention of the appropriate bureau director at the address listed in the Author References.

Author References
Donald T. Wigle, Director, Cancer Bureau, LCDC, Health Canada, Address Locator: 0602E2, Tunney's Pasture, Ottawa, Ontario K1A 0L2; Fax: (613) 941-5497
Catherine McCourt, Acting Director, Bureau of Reproductive and Child Health, LCDC, Health Canada, Address Locator: 0601E2, Tunney's Pasture, Ottawa, Ontario K1A 0L2; Fax: (613) 941-9927
Felix Li, Acting Director, Bureau of Cardiorespiratory Diseases and Diabetes, LCDC, Health Canada, Address Locator: 0602D, Tunney's Pasture, Ottawa, Ontario K1A 0L2; Fax: (613) 954-8286

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