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Section II: Analysis of Performance by Strategic Outcome

Strategic Outcome #1 - Strengthened Knowledge Base to Address Health and Health Care Priorities

Program Activity Name: Health Policy, Planning and Information

Expected Results: Strengthened health system through:

• Goals and objectives identified for specific strategies and initiatives; and
• Knowledge development and transfer of specific health policy issues

Health Risk/Outcome Area: A strengthened health system

Performance Indicators	Results
Establishment of F/P/T strategies and commitments	Led development of Patient Wait Times Guarantees (PWTGs) with provinces and territories and launched PWTG Pilot Project Fund. Implemented the Pan-Canadian Health Human Resources (HHR) Strategy. $400 million allocated to Canada Health Infoway to advance patient access and quality care through electronic health records (EHRs) and other innovations. Facilitated establishment and operations of the Mental Health Commission of Canada.
Action on specific health policy commitments	Began payments under the pre-1986/post-1990 Hepatitis C Settlement Agreement. To improve access to health services for official language minority communities, 3,181 students registered in French-language university and college health professional programs funded outside of Quebec (2003-08), and official languages training provided to 5,360 health care workers (2005-08) in Quebec.
Draft legislation and regulations released	Assisted Human Reproduction Regulations for consent to use gametes and embryos came into force on December 1, 2007. Proposed legislation to support the Food and Consumer Safety Action Plan completed for tabling in Parliament in April 2008. Achieved an 18% reduction under the Paperwork Burden Reduction initiative; on track to the 20% target by November 2008.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
263.7	1,399.2	1,357.2

Human Resources (full-time equivalents)

Planned	Actual	Difference
588	540	48

Canadians look to their federal government for leadership and partnership with others in support of a strong, accessible health system for all Canadians.  Under this program activity, we provide a leadership role by developing policy responses to issues of importance to the health of Canadians and addressing specific issues in the health system. We routinely do so in collaboration with members of the Health Portfolio and other federal departments, provincial and territorial Ministries of Health, and non-governmental, professional, research, and international organizations.  With those partners and independently, we promote and support national coordination and development of a strong, shared knowledge base on health issues. We support research and analysis to facilitate health system adaptation to societal, technological, industrial and environmental changes so that Canadians are protected from health risks, have access to quality health care, and gain positive health benefits from information and innovation.

We achieve these objectives through our own actions and through grants and contributions to partners.  Our efforts include: managing funding programs to stimulate health system research and renewal, administering the Canada Health Act, drafting legislation and regulations, developing and distributing federal position papers on emerging issues, and providing policy advice to the Minister. 

During the year, we made important progress on two major issues that we had identified as priorities in the Report on Plans and Priorities (RPP). The first was to move forward on the Government's Patient Wait Times Guarantees and to collaborate with our partners in tackling key factors in health system improvement: a health human resources strategy, technological innovation and health care system research.  The second was to continue coordinating and improving pandemic influenza preparedness and response in Canada and contributing to international progress on the issue.  In the RPP, we also committed to support renewed health protection legislation and modernization of the related regulatory system to enhance the safety of consumers, patients and workers.  Much of that work helped pave the way for the Food and Consumer Safety Action Plan that is described under Strategic Outcomes 2 and 3, later in this Section.

Health Care Policy

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
146.2	172.6	169.7

Expected Results: Improved access, quality and integration of health care services for all Canadians

Performance Indicators

Results

Establishment of F/P/T strategies and commitments   Interim and summative evaluations of funding programs   Progress reports on health care renewal from the Health Council

Supported development of Patient Wait Times Guarantees (PWTGs) to provide patients with greater certainty of timely access to quality health care services. Launched the PWTG Pilot Project Fund. Funded initiatives that promote planning and management of Health Human Resources (HHR) as part of the Pan-Canadian HHR Strategy Continued to implement the Internationally Educated Health Professionals Initiative: 27 multi-year contribution agreements support over 50 initiatives. Developed an action plan following completion of an evaluation of the Primary Health Care Transition Fund (PHCTF).  Continued to support the Health Council's monitoring and reporting role in implementation of the 2003 and 2004 Health Accords. Supported initiatives to improve Canadians' access to quality health care through development and sharing of knowledge and resources. Facilitated establishment of the Mental Health Commission of Canada. Began payments to eligible applicants for the pre-1986/post-1990 Hepatitis C Settlement Agreement.

There were six major areas of importance to Canadians under the Health Care Policy sub-activity.

Wait Times Management and Health Care Renewal

The Health Council of Canada, the Wait Times Alliance and the Canadian Medical Association all report that progress is being made in reducing wait times within the five priority areas identified in the 2004 Health Accord - cancer treatment, heart procedures, diagnostic imaging, joint replacement and sight restoration.  The efforts and investments of all governments, and of health care institutions and providers across the country, have contributed to this important progress.

Our highest profile priority was to support development of Patient Wait Times Guarantees (PWTGs) to provide patients with greater certainty of timely access to quality health care services.  Following the agreement of each provincial and territorial government to establish a PWTG by March 2010, we launched the PWTG Pilot Project Fund.  With this Fund, interested provinces and territories are testing and evaluating innovative approaches to establishing PWTGs, including options for alternate care (recourse) when established time frames have been exceeded.  These projects will help provincial and territorial governments develop guarantees that will move the health system toward more responsive, patient-centred care.  For our part, we continued to directly support and oversee four pilot projects: three to establish guarantees for diabetes and prenatal care in selected First Nations communities and a fourth for paediatric surgical wait times.

Under the National Wait Times Initiative (NWTI),[2] Health Canada partnered with stakeholders in supporting research, knowledge development and dissemination in order to inform policies, programs and services aimed at improving access to care and reducing wait times. Work sponsored included: a roundtable and research paper on mental health wait times, a workshop to share a synthesis of wait times research by the Canadian Institutes of Health Research (CIHR), and a "Taming of the Queue" Conference.

Our Department continued to support the Health Council's monitoring and reporting role concerning implementation of the 2003 and 2004 Health Accords.  The Council published its third annual report, as well as issue-specific reports with more detailed analysis of issues such as primary health care and home care.  It also released: Why Health Care Renewal Matters: Learning from Canadians with Chronic Health Conditions and Why Health Care Renewal Matters: Lessons from Diabetes.

The Department renewed support for the Canadian Patient Safety Institute (CPSI)[3] for a further five years, with funding of up to $8 million per year. This will enable CPSI to continue to provide leadership, foster collaboration and promote improvements in patient safety and quality of care.

Health Human Resources Strategies

Health Canada continues to implement the Pan-Canadian HHR Strategy,[4] which provides up to $20 million annually for activities that promote planning and management of HHR. These activities are meant to ensure that Canadians have access to the health providers they need. The Strategy includes three initiatives: Pan-Canadian HHR Planning; Interprofessional Education for Collaborative Patient-Centred Practice; and Recruitment and Retention.

Much of our support involved funding to stakeholder-driven initiatives.  For example, we are collaborating with Statistics Canada to assess and report on statistics related to the education of health professionals in Canada to examine the reasons for attrition.  The Department also supported the Association of Faculties of Medicine of Canada's review of undergraduate medical education in Canada to promote excellence in patient care. We funded the Canadian Federation of Nurses Unions to identify measures that unions and employers can undertake together to promote quality work life practices that will improve retention and recruitment of nurses and the quality of patient care.

In partnership with governments, regulatory bodies, and academic organizations, Health Canada continues to implement the Internationally Educated Health Professionals Initiative (IEHPI),[5] for which the federal government committed $75 million over five years, beginning in 2005-2006.  The goal is to facilitate integration of health professionals educated in other countries into the Canadian work force.  Provinces, territories, and non-governmental organizations have funding for 27 agreements that are supporting over 50 initiatives, often designed to achieve a more standardized approach to assessing international graduates.  Highlights include an innovative competency assessment centre for internationally educated nurses in Alberta, now being expanded across the country, and a faculty development program for teachers of international medical graduates, that was fully implemented in all 16 Canadian medical schools.

An evaluation of the Health Care Strategies and Policy Contribution Program, which includes delivery of the Pan-Canadian HHR Strategy, the IEHPI, the NWTI and the PWTG Pilot Project Fund was completed in December 2007.  It found that the Program addresses issues relevant to today's health care system and provides a flexible mechanism to address emerging health care issues quickly.  However, it also recommended a more objective-oriented performance measurement system, improved information dissemination and knowledge transfer mechanisms; and improved strategic governance of the Program to better inform allocation decisions, increase coordination and collaboration of and between projects and foster broadened application of project results. We are drawing on these results as the Program moves forward.

Home and Continuing Care, Chronic Disease Management, e-Health

Electronic health records (EHRs)[6] are an important tool in improving quality, safety and accessibility of health care.  The Department invested an additional $400 million in Canada Health Infoway Inc. to support continued implementation of EHRs and improvements to patient access and quality care.  We also participated in an Organisation for Economic Co-operation and Development initiative examining successful strategies for implementation of EHRs.  Health Canada supported research and analysis on how best to improve integration of health care. We also supported development of a guide for regional health authorities who choose to introduce advance care planning programs, which will be available in 2008-2009.

Recognizing growing concerns about autism and interest in addressing it, we provided $1 million over five years to Simon Fraser University for a Research Chair on Autism Treatment and Intervention, in collaboration with the Government of British Columbia.  We also improved our website content related to autism and supported the Canadian Autism Intervention Research Network to update research information available to the public and ensure its availability in both official languages.

Health Canada continued to support the Government's implementation of the Canadian Strategy for Cancer Control, through funding of up to $50 million a year to the Canadian Partnership Against Cancer Corporation and through support for an ongoing policy dialogue with Australia on national cancer control approaches.

We conducted a final evaluation of the Primary Health Care Transition Fund (PHCTF).[7] The Fund (2000-2006) supported provinces, territories and other health care system stakeholders as they developed and implemented initiatives such as interdisciplinary teams of providers and improvements in access, health promotion, disease and injury prevention, chronic disease management, quality of care, accountability, and integration of services.  The evaluation found that the PHCTF had been a significant catalyst for primary health care system reform and renewal. It also generated recommendations that resulted in a management action plan.

Mental Health

The Department facilitated establishment of the Mental Health Commission of Canada.[8]  Announced in Budget 2007 and officially launched by the Prime Minister in August 2007, the Government committed $130 million over 10 years to enable the Commission to serve as the focal point for mental health and mental illness. Budget 2008 committed an additional $110 million to support the Commission's national research projects related to mental health and homelessness.  Since its establishment, the Commission has: established its governance structure and organizational design, including a Board of Directors and eight Advisory Committees; developed governance and administrative policies, and hired senior staff; conducted consultation sessions with stakeholders across Canada, launched studies and start-up activities; and, developed a five-year business plan.

Hepatitis C

Following completion of the pre-1986/post-1990 Hepatitis C Settlement Agreement, payments were initiated for eligible applicants.

Pharmaceuticals Management

In the RPP, we outlined plans for continued work with the provinces and territories on elements of the National Pharmaceuticals Strategy (NPS). The federal focus on the NPS continues to emphasize the importance and value of federal-provincial-territorial (F/P/T) collaborative work on drug utilization, management and costs to enhance system efficiency, health outcomes and equity, while supporting sustainability.  As provincial and territorial governments continue to focus on securing new federal funding for drug coverage, progress on the NPS has been challenging, and governments will need to determine how best to continue collaboration on shared pharmaceuticals issues.  Despite this,  plans outlined in the RPP have been largely realized:

• Options for Catastrophic Drug Coverage (CDC) have been analyzed and costed.  Recent expansions in provincial public drug coverage appear to have been based, in part, on this work. 
• In the NPS priority area, Expensive Drugs for Rare Diseases, we continued our collaboration on the three-year Canadian Fabry Disease Initiative Study (CFDI).[9]  While focusing on a single rare disease, the study's aim is to inform how we can best assess the effectiveness of all rare disease drugs, and make evidence-based decisions on public reimbursement for these drugs.
• Under the NPS element, Common Drug Formulary, we collaborated with officials from F/P/T drug plans to provide advice and policy direction to the Canadian Expert Drug Advisory Committee (CEDAC)[10] in support of expansion and improvement of the F/P/T Common Drug Review (CDR),[11] whose recommendations inform public drug reimbursement in all provinces (except Quebec, which does not participate in the NPS or CDR).
• We contributed to the Government Response to the 2007 Study of the CDR by the House of Commons Standing Committee on Health, which found that participating drug plans view the CDR as a positive example of intergovernmental cooperation that provides valuable service to the public.[12] The Canadian Agency for Drugs and Technologies in Health (CADTH)[13] is responsible for the CDR as well as the Canadian Optimal Medication Prescribing and Utilization Service.  A 2007 third-party evaluation of CADTH's performance indicated that participating F/P/T drug plans view the CDR's impacts as "entirely positive,"[14] and internal monitoring and analysis at CADTH confirms that the CDR has decreased overlap and duplication, increased efficiency, consistency and decision-making rigor, and has resulted in a more than 90 percent uptake of listing recommendations by F/P/T drug plans.
• In the Drug Pricing and Purchasing priority area of the NPS, and pursuant to previous agreements by F/P/T Health Ministers, we funded the Patented Medicine Prices Review Board (PMPRB) to monitor and report on non-patent and off-patent prescription drug sales and pricing indicators.[15]
• For the Real World Drug Safety and Effectiveness element of the NPS,[16] we collaborated with partners to develop a business plan that proposes a virtual network to link Centres of Excellence in post-market drug safety and effectiveness research in order to close evidence gaps and develop needed research capacity.  Provinces and territories have expressed interest in sharing data to support such a network.

Nursing

Health Canada works with provincial and territorial principal nursing advisors, federal government nursing colleagues, and national nursing organizations to address priority policy concerns.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
3.7	3.7	3.6

Expected Results: Optimize the contribution of nursing knowledge and practice to improve health care for Canadians

Performance Indicators	Results
Progress on nursing policies and practices (as specified in work plans and funding agreements)	Strengthened role of nurses in health care system through consultation and advice. Contributed to broad evidence-based policy work by: 1) supporting and participating in research; 2) producing policy papers; and 3) linking research and practice with health care providers. Facilitated F/P/T linkages through national committees and meetings.

To address opportunities for nursing knowledge and practice to improve health care we:

• produced policy papers on emerging nursing roles such as those on mandatory nurse-to-patient ratios for staffing, new nursing roles (e.g. nurse anaesthetists), patient safety in mental health settings, the costs of employee turnover and a national birthing strategy;
• developed with partners the NurseONE National Nursing Portal – a bilingual electronic gateway through which nurses can access professional resources and services;
• supported the activities of a national group leading efforts to improve the quality of worklife for nursing and other health professionals.  In addition to developing a National Action Strategy and national quality of worklife standards, the group has developed a website and held a national summit, both promoting knowledge exchange, leading to improved awareness of the importance of a healthy healthcare workplace;and
• worked with provincial governments and professional organizations to facilitate a Pan-Canadian approach to increase the number of nurse practitioners.

As part of promoting the healthy workplace as a component of the Pan-Canadian Health Human Resources Strategy:

• we supported projects to improve the health and well-being of front-line health care workers;
• we funded the National Expert Committee on Interprofessional Education, and funded and supported the Canadian Interprofessional Health Collaborative to facilitate knowledge transfer and networking activities.

Assisted Human Reproduction Canada Act Implementation

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
3.1	3.1	3.0

Expected Results: Implementation of Assisted Human Reproduction Act and development of related regulations - Set-up of Assisted Human Reproduction Canada (AHRC)

Performance Indicators

Results

Progress on regulatory work (milestones established in yearly work plans)   Ultimately, AHRC will report on success in promoting health and safety of those using these technologies

Regulations for consent to use gametes and embryos were published in Canada Gazette Part II in June 2007 and came into force on December 1, 2007. Drafting instructions for regulations for 13 topics were completed and regulations are being drafted.  Drafting instructions for health reporting information regulations are expected to be published in Canada Gazette Part I in 2008. The Personal Health Information Registry database was transferred to AHRC in July 2007.

By developing regulations for the Assisted Human Reproduction (AHR) sector, Health Canada is protecting against risks and injuries to health, safety, rights and dignity of Canadians. We continued to engage stakeholders on an ongoing basis to balance the needs of persons who use these technologies with those of children born from these technologies, and providers of these services and society as a whole.  During 2007 - 2008 we continued with development of AHR regulations to address the complex social and ethical and health and safety risks raised by these technologies.  After consideration of the legal and policy impacts of the Quebec Court of Appeal opinion regarding the constitutionality of the AHR Act, a decision has been taken to launch an appeal before the Supreme Court of Canada to clarify any uncertainties.

Assisted Human Reproduction Canada (AHRC) was established in 2006 to administer the Assisted Human Reproduction Act.  Once regulations are finalized and published, AHRC will be responsible for their implementation and enforcement, and for reporting of information regarding the health and safety of Canadians using AHR technologies.  In addition, we began a review of the Processing and Distribution of Semen for Conception Regulations, which fall under the Food and Drugs Act, with a view to incorporating these requirements under the AHR.

Health Sciences Policy

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
2.6	2.6	2.4

Expected Results: Contributions to action on specific health science issues

Performance Indicators

Results

Reflection of ethical, legal, social, economic and health system considerations in international and domestic partnerships and in policy advice in health science areas. Progress on a system for human research protection  (milestones specified in work plan and project agreement)

A workshop was held and a policy report commissioned on the impact of licensing in human genetics on the uptake of new diagnostics in the health system. Research on intellectual property in HIV/AIDS vaccine technologies addressed how patent protection may affect research. A forum enabled federal departments to share experiences on challenges in vaccine development and uptake. Engaged and supported the Sponsors' Table (ST) for Human Research Participant Protection in Canada, which established an Experts Committee to recommend improvements for human research participant protection. Completed year two of a stakeholder-driven process to develop a voluntary standard for research ethics boards that review clinical trials to improve research consistency and efficiency and better protect participants in clinical trials in Canada. A plan was developed to collect data on quality assurance mechanisms in Canadian laboratories conducting genetic testing, and on work to be completed in 2008-2009 to disseminate and encourage uptake of Organisation for Economic Co-operation and Development (OECD) Guidelines on Quality Assurance in Molecular Genetic Testing.

Our health science policy efforts took many forms beyond the points noted in the box above.  One focus was improved quality assurance and technology transfer in human genetics. We took part in two OECD initiatives to develop international guidelines regarding (1) management of intellectual property in human genetics, and (2) measures to ensure quality in genetic testing.  These initiatives will improve access to and the quality of gene-based health technologies. We contracted leading researchers to provide the Department with a road map for implementing the guidelines, and engaged laboratory directors, offices of technology transfer, university researchers, administrators and the private sector in a dialogue on the principles endorsed in the intellectual property guidelines. These initiatives advanced the Government's commitments in the Science and Technology Strategy related to intellectual property management and regulatory supports for innovative health technologies.

Another focus was our work with partners in early issue identification and monitoring of emerging technologies, including nanotechnology, and  policy research on potential ethical, legal and social impacts.  As part of this, we mapped the ethical, legal and social nanotechnology research in Canada in an effort to identify major stakeholders and other potential partners.  We also identified goals for specific strategies to maximize benefits and minimize/prevent harm associated with new technologies.

Health Canada conducted policy research and analysis on the ethical conduct of research involving humans, regulations for protecting human research participants, and standards for research ethics boards reviewing clinical trials.  The Department joined partners to examine models of accreditation for human research protection in Canada.  Health Canada also strengthened international linkages and harmonized practices through support and promotion of the UNESCO Declaration on Bioethics and Human Rights and by playing a lead role in OECD efforts to develop Guidelines for Human Biobanks and Genetic Research Databases. These activities contributed to the departmental goal of strengthening F/P/T linkages in human research participant protection, as well as federal efforts to improve the health of specific populations and to reduce health risks through collaboration with other governments.

Legislative and Regulatory Affairs

 Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
2.2	2.2	2.0

Expected Results: Better protection for the health and safety of consumers, workers, and patients

Performance Indicators

Results

Progress towards regulatory policy coherence across the Health Portfolio Achievement of milestones towards completion of a new framework set in annual work plans (as stated in RPP) The success of the new health protection framework will be reported on by departmental Branches and Health Portfolio organizations responsible for specific sectors e.g. food safety, consumer safety

Established a Portfolio-wide steering committee on implementation of the Cabinet Directive on Streamlining Regulation (CDSR). Began to improve the regulatory process.  Progress was made in performance measurement and cost benefit analysis, with results anticipated for 2008-2009. Achieved an 18% reduction under the Paperwork Burden Reduction initiative; on track to the 20% target by November 2008. Developed a prioritization criteria and governance model, to efficiently channel legislative and regulatory activity.

We supported the departmental process that led to development of proposed amendments to the Food and Drugs Act and a new Canada Consumer Product Safety Act that were tabled in Parliament on April 8, 2008 and are discussed under Strategic Outcomes 2 and 3. We also continued to work on legislative policy related to Health Canada and Public Health Agency of Canada (PHAC) collection, use and disclosure of personal information, as well as radiation emitting devices and passenger conveyances.

Our continued work to improve regulatory processes was in keeping with the Cabinet Directive on Streamlining Regulation and associated Treasury Board guidelines.  We made good progress in implementation, including a new requirement for performance measurement of regulatory initiatives. Our Department also ensured greater internal efficiencies in regulatory development and a reduction in unnecessary administrative burden on business.  We continued to work on measures under the Paperwork Burden Reduction Initiative.

International Affairs

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
28.0	28.1	9.0*

*Variance is due to the requirement to provide advance payment of international membership fees.

Expected Results: Contribute to enhancing global health security and protecting the health of Canadians

Performance Indicators	Results
Participation in and outcomes of conferences and meetings; establishment of joint strategies and frameworks Expected results and performance measurements relating to specific sectors will be reported on by the organizations responsible e.g. PHAC will report on pandemic preparedness	Health Canada participated in the Eighth Ministerial Meeting of the Global Health Security Initiative (GHSI). Participated in World Health Organization's Intergovernmental Working Group on Public Health Innovation and Intellectual Property. Initiated an international workshop on reducing risks to human health posed by animals.

Canada is an active contributor to health initiatives on the international stage.[17]  Our priority was to collaborate with partners such as the World Health Organization (WHO) and the Pan American Health Organization (PAHO) on pandemic influenza preparedness, HIV/AIDS and global health security.[18]  We also built our relations with countries such as China, which led to a new Canada-China Joint Committee on Health to highlight areas of future collaboration pertaining to health systems reform, financing of pharmaceuticals, and primary rural health care.

In November 2007, we participated in the Eighth Ministerial Meeting of the Global Health Security Initiative (GHSI), an informal partnership of the G7 countries plus Mexico, to strengthen public health preparedness and response globally to the threat of international chemical, biological and radio-nuclear terrorism.

As a result of issues raised by some developing countries coping with H5N1 avian influenza outbreaks, we supported the 2007 World Health Assembly decision to establish the Intergovernmental Meeting on Pandemic Preparedness that worked to ensure ongoing sharing of virus samples, to establish an international stockpile of vaccines, and to explore mechanisms and guidelines for distributing pandemic influenza vaccines.

Our role in the WHO Intergovernmental Working Group on Public Health Innovation and Intellectual Property included hosting a consultation with 28 countries of the Americas to explore positions and priorities; and supporting the WHO to strengthen its technical capacity on public health intellectual property issues, producing an expert paper on patent issues related to influenza viruses.

The Department initiated a workshop with domestic and international partners on veterinary public health. The workshop exchanged information on best practices and identified strategies for greater integration between health and agricultural expertise in the Americas to reduce risks to human health posed by animals.

Intergovernmental Affairs

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
5.6	5.6	5.1

In addition to our ongoing responsibilities,[19] we administered the Canada Health Act, investigating potential cases of non-compliance and analyzing emerging issues of relevance, such as patient charges for primary care in private facilities, possible extra-billing by physicians and charges for surgical services by private clinics. We continued to see a high level of provincial and territorial compliance that we described to Parliament and Canadians in the Canada Health Act Annual Report.[20]

Applied Research, Dissemination and Accountability

Health Canada coordinates development of useful and timely health information to Canadians, partners and stakeholders for health policy decision-making, and performance measurement and reporting, as directed by First Minister Health Accords.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
36.5	91.9	62.4*

* Variance is due primarily to the lapse of a portion of the new funding authorized for the Canadian Institute for Health Information.

Focused research that addresses the specific needs of Health Canada and other policy makers is important for good decisions.[21]  A good example of this was our continued production of the Health Policy Research Bulletin, which provides public and health sector decision-makers with in-depth evidence about health policy concerns. The latest issue explored factors affecting the health status of people in urban and rural settings. An important element of our spending was funding for the Canadian Institute for Health Information (CIHI) to collect and publicly report data on the health care system.

Of importance to other groups within Health Canada, we developed a variety of health human resource forecasting models, micro-simulation models, and associated databases to enable quantification and analysis of possible policy options and program changes.  For example, a microsimulation model measured the fiscal impact on families and individuals of changes to drug and dental program parameters in the context of a sustainability policy review.   We also developed a physician supply and demand model that helped to gauge the impact of various policy levers (e.g. more graduates, immigration, retention) to close gaps by physician specialty in Nova Scotia. This model allows planners in all provinces to assess and act on their own physician supply and demand needs.  Other activities enabled an assessment of the fiscal impacts on households of a potential pan-Canadian catastrophic pharmacare program.  We also completed research that determined the relative importance of factors contributing to nurse absenteeism, in order to facilitate development of strategic policy responses.

 Official Language Minority Community Development

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
25.7	25.8	33.5

Expected Results: Improved access to health services for official language minority communities

Performance Indicators

Results

Evaluations of funding programs (Expected results and indicators are specified in funding agreements for projects)

Began evaluation of the Contribution Program to Improve Access to Health Care Services for Official Language Minority Communities. Between 2003-2004 and 2007-2008, 3,181 students had registered in French-language university and college health professional programs funded outside of Quebec (230 graduated by March 31, 2008). Within Quebec, training provided to 5,360 health care workers (2005-2008) - English-language training to French-speaking health care workers to improve services for the Anglophone minority population, and French-language training to English-speaking workers to retain them in the Quebec labour force.

The Contribution Program to Improve Access to Health Services for Official Language Minority Communities continued to provide support for training and retention of health professionals and community networking among English-speaking communities within Quebec and French-speaking communities elsewhere in Canada.  In addition to the program data noted in the box above, since 2003, 28 minority language health networks have been created, many of which are now officially recognized by their provincial/territorial governments.

In October 2007, the Minister announced an additional $4.5 million for initiatives to improve access to health services in official language minority communities during 2007-2008.

Results of a Survey on the Vitality of Official Language Minorities were released in December 2007. The survey, a partnership involving Health Canada and nine other government departments, found that 65 percent of French-speaking adults in all provinces except Quebec indicated that the main reason it would be difficult to get health care services in French is the scarcity of French-speaking professionals. In Quebec, 70 percent of English-speaking adults cited a similar problem in receiving services in English.[22]

Strategic Outcome #2: Access to Safe and Effective Health Products and Food and Information for Healthy Choices

Program Activity Name: Health Products and Food

Expected Results:

• Access to safe and effective health products and food
• Access to information for healthy choices

Health Risk/Outcome Area: Access to safe and effective health products

Performance Indicators	Results
Number of instances of unsafe drug alerts (advisories, warnings) and health product recalls issued on the Health Canada website	42 advisories, warnings and recalls for drugs and health products disseminated to health professionals compared to 41 last year. 124 advisories, warnings and recalls for drugs and health products disseminated to the public compared to 96 last year. 21 advisories, warnings and recalls for food and nutrition disseminated to the public compared to 18 last year.
Number of inspections	Over 900 inspections conducted
Percentage of compliance based on total number of inspections (of establishments) completed	98% compliance
Percentage of new pharmaceuticals and generic drug submissions reviewed on time	94% of pharmaceutical and generic drug submissions reviewed on time according to approved service standards, exceeding target of 90%.
Percentage of biologic drug submissions reviewed on time	100% reviewed on time, exceeding target of 90%.
Percentage of pre-market submissions backlog reduced for: veterinary drugs natural health products	92% of backlogged veterinary drug submissions in workload as of April 1, 2007 completed, exceeding target of 70%. 55% of natural health product Product License Applications completed, leading to regulatory decisions.  No targets set.

Health Risk/Outcome Area: Safe food

Performance Indicators	Results
Percentage of pre-market submissions backlog reduced	93.5% of 31 oldest food submissions (phase I of backlog reduction: non-regulatory submissions)  processed.

Health Risk/Outcome Area: Access to information to make informed decisions

Performance Indicators	Results
Level of satisfaction of Canadians and health professionals with the information disseminated for healthy choices and informed decision-making	83% responded that we did an excellent job of communicating information in both official languages. 66% responded that we offer sufficient options for receiving information. 64% responded that we provide information in a timely fashion.
Number of information products disseminated related to health products and food	Over 1,480 CD ROMS distributed, providing access to information about health products and the food regulatory system. Website used for education campaign on poultry safety. Guide on nutrition labelling and claims posted on website. Human Health Risk Assessment of Mercury in Fish and Health Benefits of Fish Consumption posted on website. Social marketing campaign, including television ads, encouraged Canadians to use Nutrition Facts tables on food packages to make informed food choices.
Number of revised copies of Canada's Food Guide disseminated	Over 13 million copies of the revised Canada's Food Guide disseminated. Over 250,000 resource guides for educators and communicators distributed.
Percentage of target population reached	70%
Number and nature of tools and approaches implemented to better integrate transparency and openness into HPFB's daily business	Over 3,000 copies produced of the Policy on Public Input in the Review of Regulated Products, related guidance and associated tools and templates. Held over 150 consultations on a range of topics. Held almost 100 meetings for external advice and input. Evaluation reports posted on the Health Canada website.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
257.4	316.5	307.9

Human Resources (full-time equivalents)

Planned	Actual	Difference
2,668	2,623	45

Health Canada is responsible for the regulation of health products and food.  Our objective is to evaluate and monitor the safety, quality and effectiveness of the thousands of drugs, vaccines, medical devices, natural health products and other therapeutic products available to Canadians, as well as the nutritional quality of food.  We review veterinary drugs sold in Canada for safety and effectiveness for animals and for safety of foods derived from animals treated with these drugs.  We promote the health and well-being of Canadians by developing nutritional policies and standards such as Canada's Food Guide and by providing information to the public in newsletters such as It's Your Health.[23]

The Report on Plans and Priorities emphasized our commitment to modernize the Department's legislative and regulatory frameworks to keep pace with the rapid evolution of science and technology, existing and emerging public health challenges, consumer expectations in terms of safety, the need for transparency, international developments and other factors.  We committed to do so through continued action under the Therapeutics Access Strategy, which began in 2003-2004, as well as work under the Blueprint for Renewal II[24] and 2007-2012 Health Products and Food Strategic Plan,[25] which were published in April 2007 following extensive consultations with stakeholders.

Those efforts laid the groundwork for a prompt response by the Government to well-publicized incidents raising concerns about the safety of some health and consumer products in 2007.  It enabled our Department to support the Government quickly in developing the Food and Consumer Safety Action Plan,[26] which the Prime Minister announced in December 2007 and in preparing for the new funding for Action Plan initiatives announced in Budget 2008.  We also supported the process to draft legislation for introduction in Parliament in April 2008 to modernize the Food and Drugs Act.[27]

The results of these efforts and new authorities set out in the legislation tabled in Parliament will bring about new measures to strengthen health and safety systems. We will be able to regulate health products throughout their life cycles and we expect to put in place better tools to identify and act on food safety risks.  We will gain new authorities for compliance and enforcement, such as the power to order health product recalls as needed.[28]

At the same time as work related to the Action Plan took place, we advanced other elements of the Blueprint and Strategic Plan, such as consultations on user fee proposals for human drugs and medical devices, as well as the coming into force of the Safety of Human Cells, Tissues and Organs for Transplantation Regulations.  The Action Plan, Budget 2008 resources and user fee proposals will help Health Canada address the recommendations of the Auditor General in her November 2006 report on the allocation of resources to regulatory programs.[29]

Under the Health Products and Food Program Activity there are four sub-activities.  Achievements under each of the sub-activities are outlined below.

Pre-market Regulatory Evaluation and Process Improvement

Description: A modernized regulatory system: making regulatory functions more efficient, effective, flexible and responsible to Canadians by streamlining processes and collaborating more closely with other organizations to ensure Canada continues to have a world class regulatory environment.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
123.3	151.6	147.5

Expected Results: Timely product assessment for health products and food

Performance Indicators	Results
Percentage of decisions made within performance targets by type for submissions related to: pharmaceuticals medical devices biologics	94% of new pharmaceuticals and generic drug submissions reviewed on time (target - 90%). 73% of Class II, III, IV medical device applications reviewed on time (target - 90%). 100% of biologic drug submissions reviewed on time (target - 90%).
Percentage of pre-market submissions backlog reduced for: veterinary drugs natural health products food	92% of backlogged veterinary drug submissions in workload as of April 1, 2007 were completed (exceeding target of 70%). 93.5% of 31 oldest food submissions were processed. 55% of the natural health product Product License Applications were completed.
Expected Results: A modern regulatory system for health products and food that meets the needs of Canadians
Percentage of Blueprint for Renewal initiatives completed on schedule	Significant progress was made on Blueprint for Renewal initiatives.

Continue to improve the efficiency of the regulatory process

Using funding received in Budget 2003 under the Therapeutics Access Strategy, a five-year, $190 million initiative, we continued to reduce submission backlogs and meet international review standards for new pharmaceutical and biologic drug submissions. As the table above indicates, the new funding has enabled us to improve the timeliness of our regulatory decision-making and significantly reduce backlogs of applications awaiting decisions.  We are now exceeding our service standard targets in most areas and, for example, are well-positioned to eliminate veterinary drug submission backlogs by the end of 2008-2009.  We have completed phase 1 of our backlog reduction strategy for food submissions and created the new Standard Operating Procedures and workflow management tools to support in success in phase 2.

There were two notable exceptions to that progress trend during the year. One was for certain classes of medical devices, where timeliness was affected by the increased number and complexity of submissions.  The other was for the rapidly growing field of natural health products.  In response, we prioritized the submissions that we received to enable the processing of a greater number of applications in accordance with Natural Health Product Regulations.

We made progress on a more efficient regulatory process through a revised Cost Recovery Framework updating a 10-year-old fee regime.[30]  This Framework sets fees and service standards for regulation, licensing, and post-market surveillance of health products. A key step in 2007 was our posting of the Official Notice of Fee Proposal for Human Drugs and Medical Devices, which enabled stakeholder feedback and led to finalization of the Framework.

Modernizing our Regulatory Framework

The introduction to this Strategic Outcome described the overall process of regulatory renewal that has been taking place under the Blueprint for Renewal, the Action Plan and the proposed amendments to the Food and Drugs Act. While these are expected to lead to a framework with enhanced tools available for Health Canada to protect and promote the health and safety of the public, work is under way to modernize, where possible, regulatory frameworks under the existing Food and Drugs Act to address existing issues.  Many were identified as commitments in the Report on Plans and Priorities.

Our Department started to implement the new regulatory framework for cells, tissues and organs, and began posting proposed regulations in Canada Gazette Part II in December 2007.[31] We also continued to emphasize the value of making clinical trial information publicly accessible in registries, which enables patients, physicians, researchers and other interested stakeholders, to make more informed choices.  As an immediate step, we encouraged registration of clinical trials[32] under the existing voluntary regime, while exploring a regulatory amendment to make registration mandatory.

In October 2007, the Department published a consultation document, Management of Pre-Market Submissions for food submissions,[33] describing the proposed process for interacting with applicants during the pre-market submission review process.  A separate discussion paper, Managing Health Claims for Foods in Canada: Towards a Modernized Framework,[34] was released to support consultations.  The scope of that consultation was expanded to include front-of-package labelling, reflecting points made by the Standing Committee of the House of Commons on Health, as well as claims on food-like natural health products.

In May 2007, we completed an on-line Natural Health Products Regulatory Review to guide our choices in this growing area of interest for Canadians. The comments received have aided in preparation of new policy approaches including a new risk-based approach to regulating these products. We intend to clear the backlog of pre-market reviews by streamlining reviews of lower-risk products and focusing our  resources on products that pose higher risk.

The decision to move forward rapidly to support development of the Action Plan and other efforts to accelerate modernization of our regulatory system led us to delay to 2008-2009 some regulatory initiatives that we described in the Report on Plans and Priorities. Those issues included: regulations enabling access to unauthorized drugs for mass distribution for either an immediate emergency or in anticipation of a health emergency; revised nutrition labelling regulations; a new regulatory framework for vaccines; regulatory amendments for addition of vitamins and minerals to foods; and, publication of a new regulatory framework for blood.[35]

International Regulatory Cooperation

Canada and other countries are pursuing cooperative agreements and actions to gain efficiencies and improve information availability.  Consistent with this commitment, the Memorandum of Understanding (MOU) between Health Canada and the U.S. Food and Drug Administration (FDA) was broadened to include sharing of information about food and natural health products.  A new MOU with the Therapeutic Goods Administration (TGA) of Australia was signed regarding quality management system certification for medical devices.

Our Department signed an MOU relating to substances for pharmaceutical use with the European Directorate for the Quality of Medicines and HealthCare (EDQM).  As well, a new confidentiality arrangement with the European Commission (EC) and the European Medicines Agency (EMEA) allows for sharing of information relating to therapeutic products (pharmaceuticals, radiopharmaceuticals, biologics and natural health products) for human and veterinary use.

Information, Education and Outreach on Health Products, Food and Nutrition

Description: Responding to increased consumer interest in health issues by disseminating more information, and improving access to information that enables consumers to make appropriate decisions about health products and food safety, and nutrition. 

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
9.5	11.7	11.4

Expected Results: Public and stakeholders are aware of and have access to information that enables them to make informed decisions regarding the safety of health products, food and nutrition

Performance Indicators	Results
Number of information products disseminated related to: drugs and health products food nutrition	Over 1,480 CD ROMS distributed, providing access to information about health products and the food regulatory system. Over 13 million copies of the revised Canada's Food Guide disseminated. Over 250,000 resource guides for educators and communicators distributed (Canada's Food Guide).
Percentage of target population reached Level of satisfaction of public and health professionals with the information disseminated for healthy choices and informed decision-making	70% 83% responded that we did an excellent job of communicating information in both official languages. 66% responded that we offer sufficient options for receiving information. 64% responded that we provide information in a timely fashion.

Our commitment to information, education and outreach took many forms. We began implementing a five-year Consumer Information Strategy, a commitment in the Blueprint for Renewal II to produce consumer-friendly information on health products and food and the regulatory system.  Under the Strategy, we developed new products to improve usability and accessibility to departmental information; produced Branch reports in plain language; and, engaged patient and consumer stakeholders in three regions in a pilot education project on reporting side effects of drugs, which generated valuable feedback on how to improve reporting.

One of our best-known products is Canada's Food Guide,[36] with over 13 million copies of the revised edition disseminated between the launch in February 2007 and March 31, 2008.  We also distributed over 250,000 resource guides for educators and communicators and recorded 3.5 million visits to our Food Guide homepage.  To meet the needs of an increasingly diverse population, we launched the first national Food Guide for Aboriginal People, Eating Well with Canada's Food Guide - First Nations, Inuit and Métis in April 2007. After research to determine what information, tools or processes could assist new immigrants in making healthy food choices, we translated Canada's Food Guide into Arabic, Chinese, Korean, Farsi, Punjabi, Russian, Spanish, Tagalog, Tamil and Urdu.

Nutrition labelling became mandatory for all prepackaged foods in December 2007.  In January 2008, we launched a social marketing campaign to encourage Canadians to use the Nutrition Facts table on food products to make informed choices as they compare products. This included a 30-second television advertisement in English and French that aired from January to March 2008. The campaign also included Internet banner advertisements, a newspaper insert and a supermarket tear sheet featured in over 3,000 grocery stores. We also improved our nutrition labelling website to make information more accessible.[37]

Our Department carried out a wide range of other education, information and outreach efforts.  One example is our launch of an on-line education campaign on poultry safety in June 2007.  Others are our posting of A Guide to Developing Accurate Nutrient Values on nutrition labelling and claims as well as a Human Health Risk Assessment of Mercury in Fish and Health Benefits of Fish Consumption on our website. A consultation report on unpasteurized juice was finalized and several food allergy incidents management workshops were held with stakeholders, including industry and major food allergy consumer groups.[38]

Risk communications is increasingly important. Our MedEffect Canada website continued to provide access to our latest advisories, warnings and recalls concerning marketed therapeutic drugs, natural health products and medical devices.  The 20 percent increase in subscribers to MedEffect e-Notice shows the interest in this information.[39]

Some of our actions add to detailed knowledge of food issues.  We released a report on the Canadian Community Health Survey Cycle 2.2, Nutrition (2004): Income-Related Household Food Security in Canada that includes estimates of income-related food security status at the household, adult and child levels. It also describes a new approach to interpreting food security data, and results on the food security status of Aboriginal people off-reserve.[40]

An element of commitments under this activity was to address emerging health issues.  As part of this, we completed a Teacher's Kit on Biotechnology based on needs expressed by high school teachers and education specialists we consulted.  We also continued to lead an interdepartmental initiative to develop and implement a 21^st century "stewardship" approach to regulatory decision-making that takes a comprehensive view on products of new technologies.[41]

Monitoring Safety and Therapeutic Effectiveness and Risk Management

Description: Increasing responsiveness to specific public health issues and the ability to manage risks through development of sustainable research, monitoring and surveillance systems and stronger compliance and enforcement activities.  Increased ability to manage risks associated with the food supply, including food safety emergencies, in order to provide safer food to Canadians.

Expected Results: Strengthened safety of health products available to Canadians

Performance Indicators	Results
Compliance with the Food and Drug Act and its regulations Number of advisories, warnings and recalls for drugs and health products posted on the Health Canada website for the public and health professionals	42 advisories, warnings and recalls for drugs and health products disseminated to health professionals. 124 advisories, warnings and recalls for drugs and health products disseminated to the public. 21 advisories, warnings and recalls for food and nutrition disseminated to the public.
Expected Results: Compliance with the Food and Drugs Act and its regulations
Percentage annual increase in adverse reaction reports received Number of inspections Percentage of compliance based on total number of inspections (of establishments) completed	Increase over the previous year of 22%. Over 900 inspections were conducted, including 210 Medical Device Establishments . 98% compliance.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
110.4	135.8	132.1

Consistent with our commitment to research and surveillance in the Report on Plans and Priorities, we undertook a variety of activities to identify human health risks. An example was our risk assessment and development of risk management strategies for use of Bisphenol A in food packaging. This has led to work to classify Bisphenol A in the list of Substances on Schedule 1 of the Canadian Environmental Protection Act.  We also delivered on food-related assessments for priority substances listed under the Chemicals Management Plan and practised, improved and formalized a protocol for emergency preparedness and response related to avian influenza.

Our Medical Device Establishment inspection program conducted 210 inspections, exceeding the target of 205.  While we had set a target of 85 inspections of clinical trials for Good Clinical Practice (GCP), reflecting the two percent international benchmark for annual inspections, we were only able to conduct 33 GCP inspections.  We were hampered by staffing delays and the lengthy training that these specialized inspectors require.

We completed market surveys of two unapproved claims relating to cancer and depression.  These led to potentially harmful health products being recalled from the retail market and unapproved claims removed from websites and print advertising.  More generally, we moved forward on the Compliance and Enforcement Strategy in the Blueprint for Renewal and solicited the views of industry associations on compliance and enforcement and communication with Health Canada.  The Department conducted an industry sector scan to determine what increases or motivates compliance of specific regulated sectors.

We completed a three-year project to develop and implement the Canada Vigilance System, increasing capacity for adverse reaction information management and data mining. Our tracking of adverse reactions to drugs and other therapeutic products generated 22 percent greater volumes than in 2006-2007. An external Expert Advisory Committee on the Vigilance of Health Products was established to provide research and advice on post-market surveillance priority issues.

Transparency, Public Accountability and Stakeholder Relationships

Description: Bringing more transparency to our decision-making processes by providing more accessible information about the evidence, processes and rationale underpinning our decisions. Health Canada is also strengthening its capacity to involve the public more meaningfully and inclusively in regulatory decision-making.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
14.2	17.4	16.9

Expected Results: Transparency, accountability and openness are integrated into Health Canada's daily business

Performance Indicators	Results
Number and nature of tools and approaches implemented to better integrate transparency and openness into HPFB's daily business	Over 3,000 copies of the HPFB Policy on Public Input in the Review of Regulated Products, the related guidance and associated tools and templates were produced.

As part of the Policy on Public Input in the Review of Regulated Products and related guidance that was made public in May 2007, we developed tools and templates that enable public involvement in the day-to-day business of developing policy and programs, as well as our review of regulated products.

As indicated previously under this Strategic Outcome, the engagement of health professionals, academics, patients, consumers, industry and other stakeholders was a central feature in developing and moving forward on the Blueprint for Renewal II and the Food and Consumer Safety Action Plan. In particular we:

• Held over 150 consultations, including for the Cost Recovery Regime, Health Claims for Food, the Product Life Cycle Approach, and review of the Special Access Program.  These consultations had impacts such as the postponement of a cost recovery framework for natural health products;
• Held 51 bilateral meetings and 42 advisory committee meetings to gather advice and input from external advisors.

We posted approximately 1,500 Product Monographs on the Health Canada website. These factual, scientific documents on drug products describe the properties, claims, indications, and conditions of use as well as other information that may be required for optimal, safe, and effective use. While most monographs are only available in English, we have put procedures in place to request French language versions from the sponsors once the monographs have been finalized and authorized.[42]

Our Summary Basis of Decision (SBD) project was created to enhance the transparency of our drug and medical device regulatory review process.  Each SBD outlines the scientific and benefit/risk-based factors in Health Canada's decision to grant market authorization for a drug or medical device.  Under this project, we published 20 Notice of Decisions (NDs) and 11 SBDs for pharmaceutical human drugs; four NDs and 12 SBDs for biologics and seven NDs and five SBDs for medical devices.[43]

The Department's commitment to transparency included posting evaluation reports for the following initiatives:

• Augmenting Health Canada's Response to Bovine Spongiform Encephalopathy (BSE I) and Further Measures on BSE in the Areas of Risk Assessment and Targeted Research (BSE II)
• Canada's Access to Medicines Regime (CAMR)
• Genomics Research and Development Initiative
• Canadian Regulatory System for Biotechnology (CRSB)
• Natural Health Products Research Program

We have completed most actions taken as a result of the recommendations in these evaluations with the remainder to come during 2008-2009.  For example, the evaluation of the Natural Health Products Research Program taught us that we need to increase our communication, collaboration, coordination efforts and knowledge transfer with international partners, regulatory and academic entities, NHP practitioners, industry and consumers.

Strategic Outcome #3a: Reduced Health and Environmental Risks from Products and Substances, and Safer Living and Working Environments

Program Activity Name: Healthy Environments and Consumer Safety

Expected Results:

• Reduced health and safety risks associated with tobacco consumption and the abuse of drugs, alcohol and other substances
• Reduced risks to health and safety, and improved protection against harm associated with workplace and environmental hazards and consumer products (including cosmetics)

Health Risk/Outcome Area: Reduced health and safety risks associated with tobacco consumption and the abuse of drugs, alcohol and other substances

Performance Indicators	Results
Substance use and abuse
Reduce smoking prevalence in Canada from 19% in 2001 to 12% in 2011	Just under five million Canadians, representing 19% of the population aged 15 years and older, were smokers in 2007. Canada's smoking rate (19%) is lower than in the UK (25%), Australia (19.8%) and France (27.0%). The smoking rate in the U.S. is 17.5%.
Decrease in health-related, at-risk behaviours associated with substance use within the general population, and specifically, youth and Aboriginal persons	Provided over $6.5 million in national and regional funding for 65 community-based initiatives to prevent and/or diminish substance use/abuse. 43 clandestine laboratories were investigated and 19 dismantled. Disrupted production of 1,055,000 variegated multiple doses of meth/ecstasy/GHB (630,000 of methamphetamine, 145,000 of MDMA and 280,000 of GHB).

Health Risk/Outcome Area: Reduced risks to health and safety, and improved protection against harm associated with workplace and environmental hazards and consumer products (including cosmetics)

Performance Indicators	Results
Toxic substances/product safety
Rate of industry compliance with regulations	80% compliance rate for products inspected of targeted products expected to be non-compliant.
Workplace health and public safety
Rate of industry compliance with regulations Timely and appropriate psycho-social advice, guidance and professional services to federal employees Timely response to radiation exposure data for workers	Water Management Plans were implemented with nine major Canadian airline carriers, representing 80% of the industry. Employee Assistance Services helped clients achieve problem resolution within its short-term counselling model in 92% of cases. Provided timely, responsive and reliable customer services to 95,000 workers in 12,700 groups.
Performance Indicators	Results
Environmental health
Level of understanding of environmental health risks: percentage of Canadians who are knowledgeable about environmental impacts on their health	Environmental heath monitoring and surveillance under the Canadian Health Measures Survey and the Northern Contaminants Program is under way. Environmental health indicators are being developed. Air Quality Health Indicator launched, beginning in British Columbia and Toronto. New legislation related to Canada's Food and Consumer Safety Action Plan was tabled in Parliament in April 2008. Plans for improvement and expansion of the Chemicals Management Plan (CMP) portal/website have been developed, including documents to translate scientific information for a non-technical audience. Progress on the re-evaluation of older pesticide active ingredients: as of March 31, 2008, 274 of the 401 active ingredients had been re-evaluated Established a horizontal science framework to manage research funds collectively and align annually to CMP priority research. A Challenge Advisory Panel (experts) and CMP Stakeholder Advisory Council (NGOs/industry) established.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
333.8	357.0	334.4

Human Resources (full-time equivalents)

Planned	Actual	Difference
2,074	2,141	67

Health Canada is responsible for assessing and acting on many elements of day-to-day living that have impacts on the health of Canadians.  These include drinking water safety, air quality, radiation exposure, substance use and abuse (including alcohol), consumer product safety, tobacco and second-hand smoke, workplace health, and chemicals in the workplace and in the environment.  We are also engaged in chemical and nuclear emergency preparedness; inspection of food and potable water for the travelling public; and health contingency planning for visiting dignitaries.  This year, many of our activities responded directly to priorities outlined in the Speech from the Throne, particularly in connection with healthy environments and a safe and secure Canada.  The Department has been addressing these priorities through: compliance and regulations; standards and guidelines; increased awareness of regulated health products; enhanced involvement of stakeholders; and scientific knowledge and capacity to support decision-making.  Demonstrable progress was made in a number of key areas:

• Canada's Food and Consumer Safety Action Plan introduced a portfolio-wide approach to enhancing the safety system for food, health and consumer products.
• In partnership with Environment Canada, we moved forward on the Chemicals Management Plan (CMP) and the Clean Air Agenda (CAA).  These initiatives protect Canadians from hazardous chemicals and pollutants as part of the Government's Environmental Agenda.
• The Department continued to reduce the harmful consequences associated with substance use/abuse through prevention, treatment and enforcement activities, as well as administering the Controlled Drugs and Substances Act.  Health Canada is part of the Government's National Anti-Drug Strategy[44] announced in October 2007 and leads the development of the prevention and treatment components.
• Our Department leads the Federal Tobacco Control Strategy (FTCS).  Evaluation of the first five years of the 10-year FTCS found that many objectives had been achieved.  Health Canada identified new goals for 2007-2011 to further reduce smoking prevalence through relationships between federal, provincial and territorial governments and NGOs.

As part of Health Canada's response to the Office of the Auditor General's (OAG) 2006 report, Allocating Funds to Regulatory Programs, Health Canada reviewed all regulatory programs and activities, including those covered under this program activity.  We established multi-year management action plans to address issues requiring additional investigation or remediation.  The comprehensive reviews confirmed the need to increase capacity for management excellence, including integration of performance information into resource allocation decisions.  Activities are now supported by both an integrated planning and reporting framework as well as a new performance measurement framework.  Both frameworks will enable improved planning, stewardship of resources, monitoring and reporting.

High demand and competition for scientific and public health professionals has posed a recruitment challenge.  As a result, we developed a multi-year people management plan and launched collective staffing processes to improve our recruitment processes.

We have fulfilled our responsibilities in accordance with sustainable development principles. Building on the success of Health Canada's Sustainable Development Strategy (SDS) III, the Department developed a fourth SDS for 2007-2010.  Our Strategy reflects an approach that will enable government-wide reporting on issues such as clean air, clean water, sustainable communities and protection of the environment and human health.

Safe Environments

Health Canada conducts research, risk assessments and management, monitoring, and surveillance to protect Canadians from risks associated with chemical substances, drinking water, air quality, contaminated sites, climate change, as well as preparedness for environmental emergencies.[45]  These respond to the Department's obligations under the Canadian Environmental Protection Act (CEPA) 1999.[46]

Expected Results: Reduce, eliminate, prevent, or better manage toxic chemical substances and their use and/or exposure

Performance Indicators	Results
Establishment and maintenance of a monitoring and surveillance program to track public health and environmental priorities (for use in future years to track performance)	Environmental heath monitoring and surveillance under the Canadian Health Measures Survey and the Northern Contaminants Program is under way. Environmental health indicators are being developed.
Expected Results: Increase knowledge, understanding and involvement by Canadians in environmental health issues
Survey results on Canadians' knowledge, understanding and involvement in environmental health issues Percentage of Canadians who are more knowledgeable about how the environment impacts their health e.g. sun exposure	Baselines being developed; surveys being initiated. Air Quality Health Indicator launched, beginning in British Columbia and Toronto.
Expected Results: Improve scientific knowledge and capacity on environmental health issues
Increase in the number and types of publications authored by Health Canada and published in peer-reviewed scientific journals Extent to which risk assessment methodologies are harmonized with other countries	Baselines being developed. Information being gathered on uptake of published scientific documents (i.e. number of publications being used by the scientific community). Published scientific documents on Chemicals Management Plan (CMP) website and summaries in Canada Gazette. Participated in international meetings/workshops and Canada-U.S.-Mexico activities.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
131.1	122.1	114.0

Health Canada and Environment Canada collaborated to advance the Chemicals Management Plan (CMP)[47] and the Clean Air Agenda (CAA) as part of the Government's Environmental Agenda.

The CMP is linked to legislation such as the Canadian Environmental Protection Act,[48] the Food and Drugs Act, Hazardous Products Act and the Pest Control Products Act.  In addition to increasing health and environmental research, monitoring and tracking, the CMP provides an opportunity for industry and other stakeholders to input into the decision-making process.  The CMP places the onus on industry to supply the Government with information about how they are safely managing high priority chemical substances.

As part of the CMP "Challenge" initiative, 200 substances of highest priority were identified, leading to assessments and risk management approaches for substances such as Bisphenol A in baby bottles.

The Domestic Substances List (DSL) is a list of 23,000 substances.  When a proposed activity or use of a substance is different from the one identified in its original notification, a Significant New Activity (SNAc) can be placed on a substance. The implementation of SNAcs for approximately 56 substances no longer in commerce in Canada began.  We also completed a work plan to deal with petroleum stream substances.

Health Canada advanced Clean Air Agenda elements, such as assessment of health risks from emissions from indoor and outdoor air pollution sources, including fuels and consumer and commercial products.  The Department completed Indoor Air Quality Guidelines for ozone and carbon monoxide and developed and consulted on a priority list of indoor air contaminants as a basis for guidelines.  Work on Indoor Air Quality Guidelines for particulate matter and nitrogen dioxide began.  We also contributed to development of ambient air regulations as part of the Clean Air Regulatory Agenda.  The Department continued to refine the Air Quality Benefits Assessment Tool (AQBAT), to estimate the health benefits or damages associated with changes in Canada's ambient air quality.  Using AQBAT, we performed the initial health economic analysis and provided estimates of the benefits (physical and monetary) of proposed regulations to inform the Regulatory Framework for Air Emissions.  Research for an Air Health Indicator (AHI) also continued.

Also with Environment Canada, Health Canada launched the Air Quality Health Index (AQHI) to provide a daily measure of air pollution health impacts.[49]  The Index provides the public with information to make decisions to reduce exposure to potentially harmful effects associated with air pollution.  Implementation of the AQHI has taken place in Toronto and 14 communities in British Columbia and there are plans to expand to other Ontario cities and the Maritimes in the next year.

A summative evaluation assessed Health Canada's progress in achieving results under the Border Air Quality Strategy (BAQS) that ran from 2003-2004 to 2006-2007.  The evaluation confirmed good value for money and recommended measures to strengthen delivery of similar future activities, including a formal tracking and reporting program with clear indicators.

Radon is a radioactive gas found naturally in the environment that can seep into buildings.  Its ionizing radiation can cause cancer.  To protect Canadians from potential dangers of radon gas, the Department implemented a National Radon Strategy and a complementary work plan was developed and approved by the Federal/Provincial/Territorial Radiation Protection Committee.  We completed guidelines and held 15 workshops across Canada to reach home inspectors and other professionals involved in radon testing of homes and large buildings.  The Department developed maps to identify radon-rich areas that will receive additional focus during the upcoming public education and awareness campaign.[50]

Our Canadian Climate Change and Health Vulnerability Assessment identifies current and future vulnerabilities of Canadians and their communities to health risks associated with climate change.  Our goal was to produce a tool that health professionals, scientists and decision-makers could use to determine the best ways to prepare for and adapt to these changes.  Our Department also began to implement a climate change adaptation program and a heat alert and response system.  A special Your Health and a Changing Climate Newsletter was issued as well, to raise awareness of climate change health risks.[51]

Health Canada worked with World Health Organization (WHO) networks to enhance the safety of drinking water in small communities. Five new Guidelines for Canadian Drinking Water Quality were completed.  The Department, in collaboration with the Public Health Agency of Canada, completed a real-time alert system for Drinking Water Advisories to improve inter-jurisdictional coordination of responses to water-borne threats to health.  Federal departments adopted a Federal Water-Borne Contamination and Illness Response Protocol and use the real-time alert system.  This system will improve surveillance and understanding of the root causes of Drinking Water Advisories.[52]

Product Safety

Canada's Food and Consumer Safety Action Plan, released in December 2007, is a portfolio-wide approach to enhancing the safety system for food, health and consumer products, recognizing that safety is a shared responsibility among industry, consumers and government.  The Action Plan rests on three pillars: prevention of incidents, enhancing targeted oversight by government and rapid response in identifying and addressing risks.  A major component is the proposed Canada Consumer Product Safety Act to update the consumer product safety regime including modernization of the Radiation Emitting Devices Act, and the Cosmetic Regulations under the Food and Drugs Act.

Under the Hazardous Products Act and the Radiation Emitting Devices Act, Health Canada identifies, assesses, manages, and communicates to Canadians health and safety hazards associated with: consumer products; hazardous workplace materials; cosmetics; new chemical substances; products of biotechnology; radiation produced by radiation-emitting devices; environmental noise; and solar UV radiation.

Expected Results: Reduce risk of death, illness, and injury from exposure to hazardous products and substances associated with: consumer products; cosmetics; workplace chemicals; new chemical substances; products of biotechnology; radiation-emitting devices; environmental noise; and solar UV radiation

Performance Indicators	Results
Increased industry rate of compliance with regulations Increased public awareness of risks	New legislation related to Canada's Food and Consumer Safety Action Plan was tabled in Parliament in April 2008. Industry compliance results are to become available in 2008-2009. Subscriptions to the Consumer Product Safety Recall website increased from 800 to 5,000.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
31.2	39.2	36.6

As part of a Food and Consumer Safety Action Plan, the Prime Minister announced the Government’s intention to introduce legislation. This flowed from the Speech from the Throne, in which the Government announced that it would take action by “introducing measures on food and product safety to ensure that families have confidence in the quality and safety of what they buy.”  We supported the drafting of the proposed legislation which was introduced in Parliament in April 2008.

In response to the large number of toy recalls in 2007 in Canada, and internationally, due to excess lead in painted coatings, we launched an extensive toy and children's items sampling and testing project in 2007 and also checked lead levels in children's jewellery.[53] Based on targeted expected rate of non-compliance, more than 80 percent of products inspected were in compliance with our standards and we took enforcement action on non-complying products.[54]

The Minister of Health launched our new Consumer Product Safety Recall website[55] in October 2007.  This gave Canadians a centralized, easily searchable location to find information, including pictures, on consumer products recalled in Canada.

Since many products on sale in Canada are produced in China, an updated Memorandum of Understanding (MOU) was signed with the People's Republic of China - General Administration for Quality Supervision, Inspection and Quarantine (AQSIQ) in November 2007. The MOU allows for increased information-sharing, ensuring that Chinese manufacturers understand Canadian requirements; implementation of an emergency response mechanism; and improved safety of imported products.  Three technical working groups have been formed on toys and children's jewellery, textiles and lighters.

Health Canada continued to collaborate with various sectors in Canada and with our trading partners to implement the Globally Harmonized System of Classification and Labelling of Chemicals (GHS).[56]  We conducted technical consultations and worked on the legislative and regulatory changes necessary for domestic GHS implementation that includes harmonization to the greatest extent possible between sectors in Canada and among the North American Free Trade Agreement (NAFTA) countries.  Our Department completed risk assessments for 478 new chemicals and polymers, 156 transitional substances, three micro-organisms, and 32 U.S. Food and Drug Administration substances.

As part of the Chemicals Management Plan, Health Canada is assessing and, when appropriate, managing environmental exposure to new substances contained in Food and Drugs Act products e.g. pharmaceuticals, personal care products, cosmetics.  Consultations took place with stakeholders (industry, consumer groups and environmental NGOs) to develop more appropriate regulations.  We are also designing a nomination process for revision of the In Commerce List (approximately 9,000 substances in products regulated under the Food and Drugs Act that entered commerce in Canada between 1987 and 2001), as well as an approach for prioritization of substances for immediate assessment. 

Workplace Health and Public Safety

Expected Results: Timely and appropriate occupational health advice, guidance, and professional services to federal employees

Performance Indicators	Results
Increase in number of service requests received and completed within service standards or carried over, according to Activity Tracking System (target: less than 20% carried over)	Program is undergoing transformation at this time. Indicators will be revised depending on final transformation decision; results to be available in 2009-2010.
Expected Results: Timely and appropriate psycho-social advice, guidance and professional services to federal employees
Increase in rate of resolution of client problems within service standards (target: 80%)	Employee Assistance Services (EAS) helped clients achieve problem resolution within its short-term counselling model in 92% of cases.  Other quality assurance measures all indicate satisfaction rates that meet or surpass this indicator.
Expected Results: Timely and appropriate public health interventions related to conveyances and ancillary services
Increase in rate of implementation of water management plans within the Canadian airline industry (target: 80%) and rate of resolution of critical deficiencies (target: 90%) within service standards	Potable Water Management Plans were implemented with nine major Canadian airline carriers, representing 80% of the airline industry. The focus this year was on implementation; data to substantiate our success in resolving critical deficiencies will be available for next year's reporting cycle.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
31.1	48.8	48.4

Our Workplace Health and Public Safety Program (WHPSP)[57] provided occupational health services, advice and consultation, medical and workplace assessments, exposure prevention, control and management, as well as physical and psycho-social emergency preparedness and response for federal public servants.  The Program protects the health of the travelling public by providing food, water and sanitation inspections on passenger conveyances and provides health services for visiting dignitaries.  It coordinates cost-recovered Employee Assistance Program (EAP) services to more than one million Canadians in most of the public service, the military, RCMP, and retired DND and RCMP members and their families, with 90 percent of counselling services provided by a network of mental health professionals.  We also delivered occupational health services nationally to federal departments and agencies on behalf of the Treasury Board Secretariat (TBS).

Health Canada's own Employee Assistance Services (EAS) is a full-service EAP provider, offering confidential, professional, 24/7 bilingual counselling services on a cost-recovery basis.  Services include the Critical Incident Stress Management program that provided early identification and intervention for Health Canada nursing staff working in First Nations and Inuit communities.  This employee group was identified as a high-risk population in terms of workplace injuries, including mental health issues resulting from exposure to violence and trauma.

Health Canada continued to protect the health of the over 85 million people per year who travel to, from and within Canada on conveyances such as aircraft, ships, and their ancillary services such as airports and flight kitchens.  In June 2007, Health Canada was one of the first countries to issue Ship Sanitation Certificates in compliance with the International Health Regulations (IHRs) developed by the World Health Organization (WHO).  These Certificates are issued as a control measure to ensure that ships meet public health requirements to reduce the introduction and spread of disease between countries.  Health Canada's work with the airline industry has resulted in implementation of potable water management plans, improving the safety of water on 80 percent of Canadian-based carriers.  In addition, we increased our capacity to respond to a public health emergency with a trained cadre of environmental health officers across the country.

Health Canada's International Health Program worked with all levels of government, the private sector and embassies to provide health services to Internationally Protected Persons (IPPs) and their family members while visiting Canada.  This included events such as the North American Leaders' Summit in Montebello, Quebec.

Drug Strategy and Controlled Substances

Expected Results: Reduce health and safety risks associated with abuse of drugs, alcohol, and other controlled substances

Performance Indicators

Results

Decrease in health-related, at-risk behaviours associated with substance use within the general population, and specifically, youth and Aboriginal persons

Improved capacity to report on surveillance and monitoring activities. Provided over $6.5 million for 65 community-based initiatives to prevent and/or diminish substance use/abuse. 43 clandestine laboratories investigated and 19 labs dismantled with Drug Analysis Service assistance. Disrupted production of 1,055,000 variegated multiple doses of meth/ecstasy/GHB (630,000 of methamphetamine, 145,000 of MDMA and 280,000 of GHB). 14,812 licenses, import/export permits, authorizations and exemptions issued compared to 14,321 last year.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
76.6	84.8	80.2

As highlighted in Budget 2007, the National Anti-Drug Strategy involves the Department of Justice, Public Safety Canada and Health Canada and includes three action plans: preventing illicit drug use; treating those with illicit drug dependencies; and combating production and distribution of illicit drugs.[58]  The refocused Drug Strategy Community Initiatives Fund and the new Drug Treatment Funding Program reflect our commitment to work with non-governmental organizations such as the Canadian Centre on Substance Abuse, and provinces/territories to address illicit drugs at the community level and encourage communities and stakeholders to initiate and invest in projects.  The Strategy emphasizes the safe disruption of illicit drug operations by monitoring movement of precursor chemicals to prevent their diversion from the legal distribution chain.[59] Health Canada also contributes through Drug Analysis Service, training of law enforcement officers, aiding in the investigation of clandestine laboratories and authorizing destruction of seized controlled substances.

In 2007, we published a report, Substance Use by Canadian Youth, using 2004 Canadian Addictions Survey data.  This study found that alcohol is the most commonly used substance with 90.8 percent of youth aged 15-24 reporting use in their lifetime and 82.9 percent reporting use in the past 12 months.  Cannabis is the most commonly used illicit substance with 61.4 percent of youth having used cannabis in their lifetime.  Almost one in 10 Canadian youth reported using marihuana on a daily basis.

Our Department completed questionnaire testing and development for the new Canadian Alcohol and Drug Use Monitoring Survey, which we will launch early in 2008-2009.  Additionally, we completed the pilot phase of a monitoring system for drug seizure data in British Columbia.  The data will provide regional, provincial and national estimates of the types and quantities of drugs seized and the dates and locations of the seizures.

Through the Drug Strategy Community Initiatives Fund (DSCIF),[60] Health Canada provided $2.9 million in funding for national projects and $3.7 million for regional projects.  More than 65 health promotion and prevention projects and projects to reduce harms from substance use and abuse were supported, particularly those which targeted youth and professionals working in the field.  To better understand and enhance impacts, a case study analysis was conducted on a random selection of 10 completed DSCIF projects.  Positive outcomes included: increased awareness and knowledge of substance abuse issues, increased community involvement, increased number of networks and partnerships, and positive behaviour changes in individuals.

The Department continued to work on best practices by producing a document, Early Intervention, Outreach and Community Linkages for Youth with Substance Use Problems, as well as commissioning an uptake study on two best practices documents.  The documents were well received with over 85 percent of respondents making use of them in: identifying training needs, planning or adopting practices, validating existing programs or identifying service gaps and providing justification to obtain funding.[61]

Our Drug Analysis Service (DAS)[62] laboratories worked with law enforcement agencies to identify and analyze more than 107,000 exhibits, an increase of almost two percentage points from last year.  We processed more than 113,000 requests for authorization to destroy seized controlled substances and 43 clandestine laboratories were investigated.

We developed performance measurement strategies for this area, including meaningful performance indicators.[63]  Data will be collected and reported on in upcoming years, once the strategies are finalized and appropriate tools and systems developed.

Tobacco Control

Expected Results: Reduce smoking prevalence from 19% (2005) to 12% by 2011

Performance Indicators	Results
Canadian Tobacco Use Monitoring Survey (CTUMS) (February-June 2007)	Slightly fewer than five million people, representing 19% of the population aged 15 years and older, were current smokers, of whom 15% reported smoking daily.  These individuals reported smoking on average 15.3 cigarettes per day. CTUMS results for the first half of 2007 indicated that the overall prevalence of smokers did not change from the previous period.
Expected Results: Reduce prevalence of Canadian youth (15-17) who smoke from 15% to 9% by 2011
Canadian Tobacco Use Monitoring Survey	10% of youth aged 15-17 were smokers.  This was a decrease from the same period in 2005 when 16% of youth in this age group reported current smoking.
Expected Results: Increase number of adult Canadians who quit smoking by 1.5 million by 2011
Canadian Tobacco Use Monitoring Survey	29% of Canadians 15+ years reported being former smokers, adding up to more than 7.8 million former smokers.  Approximately 400,000 adults have quit smoking since 2005.
Expected Results: Reduce prevalence of Canadians exposed daily to second-hand smoke from 28% to 20% by 2011
Canadian Tobacco Use Monitoring Survey	24% of Canadians reported being exposed to second-hand smoke every day or almost every day. There was a downward trend from 27% in the same period in 2005.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
63.8	62.1	55.2

The Federal Tobacco Control Strategy (FTCS) was created in 2001 to provide a comprehensive, integrated and sustained approach for the Government to reduce smoking prevalence.[64]  Its goal for 2001-2011 was to reduce prevalence from 25 percent to 20 percent.  To this end, Health Canada developed and administered programs, and partnered with provinces, territories and stakeholder groups to reach individuals with appropriate tools, information and resources.  We developed, implemented and enforced regulations pursuant to the Tobacco Act and added to our knowledge base through research, monitoring, and surveillance.

An evaluation of the first five years of the FTCS found that it had achieved many of its objectives.  We received approval of a Treasury Board submission in 2007 on revised terms and conditions of the FTCS that resulted in identification of new targets and performance indicators for 2007-2011 that are set out in the table above.

In response to the Supreme Court ruling upholding the Tobacco Act in June 2007, the Minister directed the Department to update the Act and ensure youth in particular were protected from inducements to smoke.  Monitoring and analysis of emerging tobacco industry advertising continues.

At the second Conference of Parties (CoP) of the WHO Framework Convention on Tobacco Control (FCTC), Canada, along with other parties, agreed to adopt a best practices document for implementing effective protection from exposure to tobacco smoke.  Canada also participated in or led working groups to prepare guidelines on product regulation, packaging and labelling, public education, cross-border advertising, and took part in the International Negotiating Body which is developing a protocol on Illicit Trade in Tobacco Products.

Our Department continued to monitor and assess contraband tobacco activities and enhanced compliance, and explored options for the next generation of tobacco control.

Strategic Outcome #3b: Reduced Health and Environmental Risks from Products and Substances, and Safer Living and Working Environments

Program Activity Name: Pest Control Product Regulations

Expected Results:

• Access to safer pesticides
• Improved transparency and knowledge dissemination

Health Risk/Outcome Area: Access to safer pesticides

Performance Indicators	Results
Number of new reduced-risk active ingredients available for use in Canada Percentage of reduced-risk chemicals and percentage of biopesticide active ingredients registered/pending registration in the U.S. that are registered/pending registration in Canada	15 of the 20 new pesticide active ingredients registered in 2007-2008 were reduced-risk. More use of joint and collaborative reviews with other countries to address common priorities. 75% reduced-risk chemicals and 37% of biopesticide active ingredients registered/pending registration in U.S. are registered/pending registration in Canada.
Health Risk/Outcome Area: Improved transparency and knowledge dissemination
Number and type of regulatory proposals/ directives/policies published	Seven regulatory proposals, directives or discussion documents were published for consultation: Reconsideration of Decisions under the New PCPA; Use of Uncertainty and Safety Factors in the Human Health Risk Assessment of Pesticides; Guidelines for the Registration of Low-Risk Biochemicals and Other Non-Conventional Pesticides; First Aid Labelling Statements; Compliance Policy; Protection of Proprietary Interests in Pesticide Data in Canada; and Registering a New Source of Technical Grade Active Ingredient under the Protection of Proprietary Interests in Pesticide Data Policy.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
50.9	62.8	58.9

Human Resources (full-time equivalents)

Planned	Actual	Difference
652	582	70

 Health Canada's Pest Management Regulatory Agency (PMRA) regulates pest control products in Canada under the federal authority of the Pest Control Products Act (PCPA).[65] It has a mandate to prevent unacceptable risks to people and the environment from the use of pest control products. We use modern scientific techniques to assess  human and environmental health risks and efficacy when evaluating and re-evaluating pest control products. As well, maximum residue limits (MRLs) are set for pesticides on food under the Food and Drugs Act. We encourage the development and application of sustainable pest management strategies, and facilitate access to lower risk pest control products. We address public and stakeholder concerns, and develop mechanisms to give Canadian growers access to innovative pest control products so that they can remain competitive in domestic and international markets.

New regulations under the PCPA were implemented, such as mandatory incident and sales reporting regulations, which enable us to monitor adverse impacts associated with pesticides and keep track of the quantities of pesticides sold in Canada. To date, we have received and posted close to 1,000 incident reports on the PMRA Public Registry. Incident reports help to identify any potential risks to health or the environment from use of pesticides and enable us to take corrective actions when necessary.

Under the Government's Chemicals Management Plan, our Agency worked closely with other Health Canada branches and with Environment Canada to assess high priority chemical substances and make risk management decisions to help protect Canadians and the environment from any risks these substances might pose. We were also involved in various aspects of research and monitoring efforts that will help improve pesticide exposure estimates and refine pesticide risk assessments. These activities complement ongoing surveillance and monitoring programs at Environment Canada (water monitoring), the Canadian Food Inspection Agency (CFIA) (food residues), and the United States Department of Agriculture's Pesticide Data Program (US food residues). Biomonitoring results will aid in validation of current regulatory approaches and in  development of further refinements.

The Commissioner of the Environment and Sustainable Development (CESD)'s 2008 follow-up audit concluded that overall, the federal government had made satisfactory progress in managing the safety and accessibility of pesticides since 2003.[66]  We were pleased with the CESD's findings that we consistently apply procedures for evaluating the risks of pesticides, and have taken action to give Canadian growers access to new and minor-use pesticides. To address concerns regarding conditional registrations, the Agency implemented measures to limit the allowable time period of conditional registrations in the future. The planning process has been adjusted to respond to CESD's concern regarding the lack of a detailed plan to meet our re-evaluation commitments.

The first global joint review for registration of a new pesticide was completed in collaboration with the United States, United Kingdom, Ireland, Italy, Australia, New Zealand and Japan. Canada's continued participation in international regulatory cooperation activities provides Canadian growers with access to new pesticides at the same time as their global competitors. 

The four main program sub-activities that support this Strategic Outcome are discussed below.

New Pest Control Products Registration and Decision-Making

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
22.5	28.0	26.1

 Twenty new pesticide active ingredients were registered in 2007-2008, twice the number of actives registered in the previous year. As a result of this increased workload, we did not meet our performance target for the timely registration of new active ingredients. This issue has since been addressed by acquiring additional resources to review priority submissions.

Timely access to new, reduced-risk products in Canada is achieved via international regulatory cooperation such as joint review, work share and more effective utilization of foreign evaluations. This year, global and North American joint reviews and work shares resulted in registration of three new pesticide active ingredients.  To increase the availability of pesticides in Canada compared to those available in the United States (i.e. to address the technology gap), 758 new minor uses were registered, including 459 food uses and 299 non-food uses. We are working with the U.S. Environmental Protection Agency (US EPA) and other regulatory agencies to expand the use of joint reviews and work sharing for minor uses.

The Agency continues to work on several key initiatives to increase the availability of newer, lower risk pesticides in Canada to help Canadian growers remain competitive in the global market.  Four agricultural pesticides with North American Free Trade Agreement (NAFTA) labels were recently approved, which allows the cross-border movement of these products between Canada and the U.S.  The Grower Requested Own Use (GROU) program allows Canadian growers, with an approved Import Certificate, to import the U.S. version of certain Canadian registered products when price differentials exist. There are 11 GROU products approved for the 2007-2008 use season. The new policy for registering generic pesticides will protect the proprietary interests of data while encouraging introduction of competing generic pesticides to the Canadian market.

 Registered Pest Control Products Evaluation and Decision-Making

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
9.9	12.2	11.4

 The Agency has committed to re-evaluate all 401 pesticide active ingredients registered on or before December 31, 1994.  We continued to implement risk mitigation measures to address any risks that emerge during the re-evaluation of a pesticide.  In 2007-2008, 30 re-evaluations were completed, bringing the number of re-evaluated pesticide active ingredients to 274, with 127 active ingredients remaining to be re-evaluated.

We continued to work with the US EPA in developing a plan for work sharing for the next round of re-evaluations.  Two pilot chemicals were selected for this work sharing program and other candidates will be identified for future collaborative reviews.

Compliance

 The Agency is responsible for promoting, verifying and enforcing compliance with the PCPA and Regulations. As described in the Compliance Policy, published in 2007, risk management principles are used to target and select situations of most concern where non-compliance is either known or suspected to exist.

We delivered 17 National Pesticide Compliance Programs.  Six were compliance promotion programs in sectors such as pulp and paper mills, dry bean and sunflower production, while the other 11 inspection programs focused on production of blueberries, mushrooms, field and sweet

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
6.8	8.5	7.9

corn, cranberries and pears.  The 943 inspections completed generally found high levels of compliance. Another 342 investigations were conducted related to reported or detected non-compliance, and 363 enforcement responses were delivered to ensure or restore compliance.

At the international level, opportunities were explored under the NAFTA to coordinate activities and projects related to compliance and enforcement activities.  Work was also initiated through the OECD Pesticides Working Group to create international best practices for pesticide compliance.

Pesticide Risk Reduction

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
3.1	3.8	3.6

 We held consultations with stakeholders to gain national consensus on key pest management issues for lowbush blueberry and highbush blueberry, carrot and onion, raspberry, sweet corn and strawberry. Through joint work with Agriculture and Agri-Food Canada, new reduced-risk pest management practices and products are now available to agricultural growers.

Our Department is working with Canadian stakeholders to develop strategies to transition to lower risk products and management practices for pesticides being phased out through the re-evaluation process. For example, a harmonized North American approach is being developed to help the agricultural industry move from the use of azinphos methyl to lower risk pest management strategies.

Strategic Outcome #4: Better Health Outcomes and Reduction of Health Inequalities between First Nations and Inuit and Other Canadians

 Program Activity Name: First Nations and Inuit Health Programming and Services

 Expected Results:

• Improve health outcomes by ensuring the availability of, and access to, quality health services, and supporting greater control of the health system by First Nations and Inuit

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
2,130.9	2,265.4	2,227.6

Human Resources (full-time equivalents)

Planned	Actual	Difference
2,843	3,013	170

Explanation of the above financial information:

Health Risk/Outcome Area: Better health outcomes and reduction of health inequalities between First Nations and Inuit and other Canadians

Performance Indicators	Results
Life expectancy (at birth, on- and off-reserve)	While still behind the Canadian average (males 77 years, females 81 years), life expectancy for First Nations has increased.  In 1980, First Nations life expectancy for males was 60.9 years, for females - 68.0 years. By 2001, life expectancy for First Nations was estimated at 70.4 years for males and 75.5 for females, while life expectancy for Inuit was estimated at 64 years for males and 70 for females.
Birth weight	Statistics for 2000 indicate that 4.7% of First Nations births are classified as low birth weight compared with 5.6% in Canada overall. The high birth weight rate for First Nations is 21%, almost double the Canadian rate of approximately 13%. Health Canada is working in maternal and prenatal health to improve these outcomes.[67]
Mortality	First Nations overall mortality is 45% higher than the rest of Canada.[68]
Rates of conditions by type	Diabetes rates: For First Nations on-reserve - 3.8 times higher than the rest of Canada. For Inuit - 47% lower than the rest of Canada.[69] Suicide rates: For First Nations youth (10 to 19 years) - 4.3 times greater than the rest of Canada in 2000.[70] For Inuit regions - 8.3 times higher than the rest of Canada. The rate for males is over 4 times higher than the female rate[71] (1989-2003). Incidence of tuberculosis (rate per 100,000 population):[72] Canada - 5.0 Registered Indians - 29.0 (5.8 times higher) Inuit - 114.3 (22.9 times higher)
Non-Insured Health Benefits (NIHB) Client utilization rates - (percentage of eligible clients who receive at least one pharmacy benefit paid through the Health Information and Claims Processing Services system in a fiscal year.)		In 2006-2007, the national utilization rate was 64%. Regional rates ranged from 74% in Saskatchewan to 47% in the N.W.T. and Nunavut. (These are consistent with previous years' utilization rates).

As outlined in the RPP, Health Canada worked with First Nations and Inuit and other health partners to deliver programs and services that can be categorized under four main priorities, which cut across the sub-program activities for First Nations and Inuit Health listed at the end of this section.

Continued health-related programs and services

Most spending under this Strategic Outcome went to a full range of health services that Health Canada funded for delivery by others or provided directly.[73]  In partnership with First Nations and Inuit, Health Canada provided primary health care services in approximately 200 remote communities, and home and community care in more than 600 communities. Health Canada directly employed 670 nurses.  Including nurses funded by the Department but employed by First Nations communities, the total nursing work force is about 1,100.

Through Regional Offices and with First Nations and Inuit, Health Canada delivered community programs[74] focused on children and youth, mental health and addictions, environmental health, and communicable and chronic disease prevention and management.[75] These supplemented and supported health services that provincial, territorial and regional health authorities provided. Through the Non-Insured Health Benefits (NIHB) Program,[76] Health Canada provided supplementary benefits to all eligible First Nations and Inuit regardless of their place of residence. These included coverage for drug, dental care, vision care, medical supplies and equipment, short-term crisis intervention mental health services, and medical transportation.  We pursued actions to enhance client safety under NIHB such as launching point-of-sale warning and rejection messages to pharmacies concerning drugs subject to misuse; changing the formulary benefit status of certain drugs subject to misuse; and intervening with health care professionals in situations where clients were identified to be at risk in relation to their use of asthma medications.

As we pursue these continuing responsibilities, our Department faces the same challenges as other health care providers, such as increasing costs, demand for new health technologies, health human resources shortages and an aging population. Additionally, the First Nations and Inuit health system serves rapidly growing populations that demonstrate higher than average rates of disease and injuries.  We face the costs of serving populations that are often dispersed across many small communities in rural and remote areas.  Improving First Nations and Inuit health outcomes also requires action on the broader determinants of health, such as economic development, education, housing and culture.

Improving quality of and access to health-related programs and services

 Our approach to addressing issues related to health program and service access and quality had a number of elements.

One of the most important was to attract the nursing staff needed to provide our services to First Nations and Inuit.  We invested in marketing materials, recruitment tools and targeted efforts to attract new nursing graduates, Aboriginal nurses and nurse practitioners.  As a result, vacancy rates improved for nursing positions on-reserve. We also developed a mentoring program to attract Aboriginal candidates entering nursing programs and a "Toolkit" to enhance nursing services. We also worked towards ensuring that nurses are prepared and supported to obtain the clinical expertise they need.

More generally, we worked with partners to increase the number of Aboriginal health care providers, including partnerships with professional associations, colleges and universities that fit with the Aboriginal Health Human Resources Initiative (AHHRI).[77]  Through participation on the federal/provincial/territorial Advisory Committee on Health Delivery and Human Resources and specific provincial actions, we integrated work under AHHRI with provincial and territorial health human resources planning wherever possible. The AHHRI has meant a 600 percent increase in funds to support First Nations, Inuit and Métis health career students, resulting in more than 500 Aboriginal students receiving such bursaries and scholarships.

As part of the Government of Canada's effort to ensure that Canadians receive essential health care within clinically acceptable wait times, the Department prepared to implement 10 pilot projects for diabetes and 10 for prenatal care to test wait times for First Nations on-reserve.

Our Department continued to provide services under the Children's Oral Health Initiative in over 150 communities and launched the Oral Health Information System to collect performance information that will enable us to measure program effectiveness.

To improve the working environment of clients and staff and enhance community health care, we invested $9.9 million towards the completion of 14 construction, expansion and recapitalization projects.  An additional $1.5 million was invested in environmental management projects to ensure that operations met environmental codes and were consistent with the Department's commitments to sustainable development.

Our Department completed six environmental site assessments and remedial activities at 10 contaminated sites on-reserve.  Of 56 contaminated sites on-reserve, 44 have been remediated, with the rest to be completed by 2012.  We also inspected 94 fuel storage tanks, upgraded or replaced three tanks, and provided training in 27 communities to improve First Nations capacity to look after sites.

Through the Aboriginal Health Transition Fund and with provincial, territorial, and Aboriginal partners, we funded over 150 projects now being implemented to improve access to health services.  Activities to integrate and adapt existing services included: work on governance structures, adapted and integrated protocol development across health systems, integrated information management, health system navigation tools, and training and cultural sensitivity in health services delivery.  Early results are: increased collaboration between Aboriginal organizations and governments; more awareness of barriers and enablers that affect access; and greater capacity for tripartite activity.

Integration projects pioneered through the Fund have informed British Columbia's Tripartite First Nations Health Plan, with other provinces now interested in province-wide tripartite discussions.  Project initiation has taken longer than anticipated due to time needed to build relationships, and develop and implement projects.

Promoting healthy living and disease prevention

Health Canada funds or delivers a wide array of programs and services meant to promote healthy living at all ages and to address key threats to the health of First Nations and Inuit.  For example, the Maternal Child Health Program for pregnant First Nations women and families with infants and young children living on-reserve continued, with 76 projects serving 176 communities. We also supported training for 60 home visitors and nurses, increasing trained Maternal Child Health workers to 110. In the North, funds enhanced health promotion programs related to the Canada Prenatal Nutrition Program and Fetal Alcohol Spectrum Disorder.[78]

The Aboriginal Head Start On-Reserve Program[79] provided over 9,000 First Nations children, ages 0-6, with a positive sense of themselves, a desire for learning and opportunities to develop fully.  Since a number of federal departments have recognized the need to streamline their Early Childhood Development programming, we were engaged in demonstration projects that were implemented in 17 First Nations communities. All are testing consolidated reporting, 16 are exploring a single funding window and six are testing integration of community development approaches.

We undertook health infrastructure work to support long-term healing in Labrador Innu communities. A Healing Lodge and Wellness Centre, including an Aboriginal Head Start site, opened in June 2007, and youth safehouses in Natuashish and Sheshatshiu are operational.

The number of community-based National Aboriginal Youth Suicide Prevention Strategy projects funded and operated rose from 100 to 140. Projects focus on prevention, skills training and development of crises response protocols.  We also undertook research to increase knowledge of effective prevention approaches and impacts of youth suicide. Five multi-year mental health promotion demonstration projects are now operating to test best practices.  To further raise awareness, knowledge and resiliency among youth, the Department, with partners, developed a public education campaign, "Honouring Life Network"; launched a web-based information centre for Aboriginal youth and youth workers;[80]  and developed a social marketing campaign including production of a toolkit for front-line workers.

A First Nations and Inuit Mental Wellness Strategic Action Plan aims to improve Aboriginal mental wellness through a coordinated continuum of mental health and addictions services that respect traditional, cultural and mainstream approaches to healing.  The Plan has been validated by the Inuit Tapiriit Kanatami. Full validation by the Assembly of First Nations is expected in 2008-2009. 

Our Department continued to address high rates of diabetes by providing services to more than 600 First Nations and Inuit communities. Training was offered to enhance skills of community diabetes workers and increase the number of trained community service providers. Work to establish multi-disciplinary teams was initiated and will continue into 2008-2009. These teams bring together regional leads, nutritionists, case care coordinators and physical activity coordinators.  Participatory research to gather more data on pre-diabetes, diabetes and its complications, and to develop strategies to reduce the burden of the disease, was also undertaken.

Complementary prevention and promotion projects were completed, such as the launch of Canada's Food Guide, tailored to First Nations, Inuit and Métis, and implementation of a food security interventions framework in partnership with Aboriginal organizations and other stakeholders.  In addition to services offered on-reserve and in Inuit communities, the Department funded 50 Métis, off-reserve and urban Inuit diabetes prevention/promotion projects.

To identify positive impacts and lessons to be worked into future efforts, we funded an evaluation of the Aboriginal Diabetes Initiative.[81] Though focused on implementation issues, the evaluation found preliminary evidence of positive health impacts that will be examined through future studies and evaluations.

We continued to ensure access to mental health and emotional supports for eligible former students of Indian residential schools.  The number of Resolution Health Support Workers increased from 53 in October 2007 to 111 by April 2008.  Forty First Nations Elders were engaged to provide cultural support. Innovative approaches were implemented, such as community gatherings, community support groups and teams, healing circles, and placing workers within National Native Alcohol and Drug Abuse Program Treatment Centres.  We also supported the Truth and Reconciliation Commission and the Independent Assessment Process by ensuring that appropriate health supports were available in a timely and effective manner.

All seven Regional Offices have a pandemic plan and are supporting 400 First Nations communities in planning, testing and integrating their plans with those of provincial, regional and local authorities.  Funds were also invested to increase the national stockpile of personal protective equipment, which will protect on-reserve health care workers during a pandemic.

We provided funding for the National First Nations Environmental Contaminants Program and the Northern Contaminants Program through six community-based projects on the health effects of environmental contaminants on reserves.  The Environmental Contaminants Traditional Food Safety Workshop in the Yukon was conducted by the Council of Yukon First Nations with Health Canada's support, to discuss findings about traditional foods.

We have made changes to develop drinking water advisories that are more cohesive, holistic and culturally appropriate to address potential water-borne threats to health in First Nations communities south of 60.  By 2006-2007, following significant departmental investments, 89 percent of community sites had access to portable lab kits for bacteriological analysis of drinking water.  This year, 95 percent had access to a trained community-based water monitor, an increase of eight percent from a year earlier.[82]

The First Nations Indoor Air Quality Committee, composed of federal and Assembly of First Nations representatives, was developing tools for First Nations to assess the severity of mould problems on-reserve and steps to take to improve housing conditions.

Improving accountability and performance measurement

We carried out a variety of actions to improve the capacity to measure indicators of health and issues affecting it as well as initiatives such as evaluations, in addition to those mentioned previously, that enable us to assess and improve policies, programs and services.

Our Department has been working with partners to improve data quality on demographics and vital statistics, life expectancy, mortality, notifiable infectious diseases, morbidity, and non-medical determinants of health for First Nations living on-reserve. "The Statistical Profile on the Health of First Nations in Canada" is planned for publication in 2008-2009 by collating data from many federal sources, although we recognize the challenges in data coverage and quality since information is not consistent nationally.

A total of $4 million was provided for the "First Nations Regional Longitudinal Health Survey (RHS)," developed and administered by First Nations. The survey is integrating traditional indigenous knowledge and a holistic health model into a scientifically rigorous survey design with preliminary results expected in 2009-2010.

Health Canada, with provinces and territories, has been developing and implementing the Pan Canadian Public Health Surveillance and Management Information System (Panorama).  We intend to facilitate its implementation in all First Nations communities in conjunction with provincial implementation over the next two to five years.

The Health Integration Initiative (HII) was operated between 2003 and 2006 to explore better integration of federally funded health services within First Nations and Inuit communities and health services funded by provincial and territorial governments.  It involved First Nations and Inuit communities and organizations, Regional Offices, and provincial and territorial health ministry representatives or regional health authorities in eight pilot projects as well as workshops and commissioned research scans.  The national evaluation report, released during 2007-2008, found that formalized partnerships were the ones most likely to be sustained after program support ended.  It also determined that due to differences in geographic location, size, and existing relationships among service providers, no single approach would apply to all communities.

Another evaluation assessed the First Nations Water Management Strategy.  It found progress in the last five years including increased capacity for Health Canada staff and First Nations communities to sample and test drinking water quality at tap. It also generated recommendations that are being addressed through the First Nations Water and Wastewater Action Plan.

Program and Service Descriptions and Funding Details

In the RPP, the Department identified the sub-activities under our Program Activity Architecture that were the organizational base for our initiatives across the priorities described previously. The charts below set out details regarding our use of resources, expected results, performance indicators and results achieved for each of those sub-activities.

First Nations and Inuit Community Health Programs

First Nations and Inuit Community Health Programs support community-based initiatives in three areas: Children and Youth; Chronic Disease and Injury Prevention; and Mental Health and Addictions.  With children and youth, the objective is to improve the health of mothers, infants and families, as well as support the development of children.[83]  In chronic disease and unintentional injury, the objective is to deliver services that reduce chronic diseases, such as type-2 diabetes, and injuries.[84]  Finally, in mental health and addictions, the objective is to deliver prevention and promotion activities on-reserve and in Inuit communities to improve physical, social, emotional and spiritual well-being.

Expected Results: Improved continuum of programs and supports in First Nations and Inuit communities

Performance Indicators	Results
Number of communities with programs	The Maternal Child Health Program for pregnant First Nations women and families with infants and young children living on-reserve supported 76 projects serving 176 communities. In Ontario, we enhanced provincial maternal and child health-related services. Over 600 First Nations communities had access to the National Native Alcohol and Drug Abuse Program,[85] the Youth Solvent Abuse Program and mental health/wellness programs; 140 community-based suicide prevention projects were delivered. Expanded cultural and mental wellness support for up to 80,000 former Indian residential school students was in place.
	Over 300 First Nations communities had access to Aboriginal Head Start programs. More than 600 communities had access to health promotion and diabetes prevention services.

Expected Results: Increased participation of Aboriginal individuals, families, and communities in programs and supports

Performance Indicators	Results
Number and type of participants in programs by program type   Number of treatment centres by type	Approximately 9,000 children participated in Aboriginal Head Start On-Reserve programs. All 80,000 former students of residential schools and their families could access health supports via the Indian Residential Schools Resolution Health Support Program.[86] 54 Alcohol and Drug Abuse and seven Youth Solvent Abuse treatment centres were in operation.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
340.7	334.6	331.8

First Nations and Inuit Health Protection

Health Canada works with the provinces and First Nations communities to support a public health system on-reserve that includes basic services: communicable disease control and surveillance; prenatal education; immunization; and environmental health services (drinking water testing, health inspections etc.).

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
80.5	79.4	72.9

First Nations and Inuit Primary Health Care

 Health Canada provides directly or funds 24/7 primary care treatment at 76 nursing stations on remote reserves, where no provincial services are readily available, and funds or provides access to home and community care such as nursing, personal care and respite in First Nations and Inuit communities.

Expected Results: Improved access to communicable disease prevention and control programs for First Nations and Inuit individuals, families and communities

Performance Indicators	Results
Number and percentage of communities with programs	All First Nations communities on-reserve supported in communicable disease prevention and control programs. Inuit communities south of 60° supported through contribution agreement funding or indirectly through National Aboriginal Organizations or transfer agreements.
Expected Results: Improved environmental health risk management
Number of communities with access to a community-based water monitor	94.9% of communities had access to a trained community-based water monitor.
Number of communities with access to on-site kits for bacteriological parameters	89.3% of communities had access to portable lab kits for on-site bacteriological analysis of drinking water.
Number of contaminated sites remediated	44 of 56 contaminated sites remediated.

Expected Results: Improved access to primary care programs and services for First Nations and Inuit individuals, families and communities

Performance Indicators	Results
Number and percentage of communities with programs	94% of First Nations communities have access to home care services (97% of eligible population). 100% of Inuit communities have access to home care services (100% of eligible population). Primary care is available in about 200 remote communities.

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
264.4	271.9	309.2

Non-Insured Health Benefits (supplementary) for First Nations and Inuit

The Non-Insured Health Benefits (NIHB) Program provides approximately 800,000 eligible First Nations and Inuit with a limited range of medically necessary health-related goods and services not provided through private insurance plans, provincial/territorial health or social programs or other publicly funded programs. The benefits include prescription drugs, dental and vision care, medical supplies and equipment, short-term crisis intervention mental health services, medical transportation to access services not available on-reserve or in the community of residence, and health care premiums in Alberta and British Columbia.  An Annual Report on the Program is available.[87]

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
939.8	1,039.0	1,029.0

Governance and Infrastructure Support to First Nations and Inuit Health System

Health Governance and Infrastructure Support aims to increase First Nations and Inuit control over health programs, establish adequate First Nations and Inuit infrastructure and health services and improve capacity to generate and use health information. These activities include: health facilities; health planning and management; capacity building; consultation and liaison; integration and coordination of health services; stewardship and health research; knowledge and information management; health human resources; e-Health services; and health services accreditation.

Expected Results: Increase the number of bridging, access and student support programs for Aboriginal health career students at post-secondary institutions

Performance Indicators	Results
Number of bridging, access and student support programs	32 projects funded: 18 bridging/access and or laddering programs 14 student support programs.
Expected Results: Facilitate the adaptation of medical, nursing and other health care curricula to increase the cultural awareness of doctors, nurses and others providing health services
Number of health science faculties adapting their curricula to improve cultural competency of health care providers.	29 post-secondary education projects funded to adapt health sciences curricula, increasing cultural competency. A framework for cultural competency developed for implementation in all 17 medical schools.
Expected Results: Increase the funding available through bursaries and scholarships to help support First Nations, Inuit and Métis students in health career studies
Number of Aboriginal students who received Health Career bursaries and scholarships	Through the National Aboriginal Achievement Foundation, 247 bursaries and scholarships were awarded to First Nations, Inuit and Métis health career students. Through the Métis National Council, 376 bursaries and scholarships were awarded to Métis health career students.
Expected Results: Health facilities
Number of health facilities	Maintained by recipient - 948 Maintained by Health Canada - 34
Expected Results: Access to quality health services
Number of health facilities and services accredited	65 First Nations organizations were engaged in health services accreditation, with several more preparing to begin the process.
Expected Results: Improved e-Health access in First Nations and Inuit communities and regions
Number of telehealth sites deployed by community and region Number of communities with Internet connections	156 telehealth sites were active in First Nations communities with 72 more in the final stages of planning and/or deployment. About 90% of communities have some form of connectivity (as of 2007).
Expected Results: First Nations and Inuit community ownership, effective control and capacity to manage and administer health programs and services
Number of contribution agreements by type[88]	Flexible - 2  • Transfer - 158  • Transitional - 82  • Integrated - 208 General - 1,230  • Set - 2

Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
505.5	540.5	484.7

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