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ARCHIVED - RPP 2007-2008
Health Canada
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Section 2: Analysis of Program Activities by Strategic Outcome
Strategic Outcome: Reduced Health and Environmental Risks from Products and Substances, and Safer Living and Working Environments
Program Activity Description
Healthy Environments and Consumer Safety touches many elements of day-to-day living that have an impact 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 secondhand smoke, workplace health, and chemicals in the workplace and in the environment. Much of this work is governed through legislation including the Food and Drugs Act, the Controlled Drugs and Substances Act, the Hazardous Products Act, the Radiation Emitting Devices Act, the Canadian Environmental Protection Act, the Tobacco Act, the Quarantine Act, the Potable Water Regulations for Common Carriers, and others. Health Canada is also engaged in other health and safety related activities such as chemical and nuclear emergency preparedness; inspection of food and potable water for the travelling public; and health contingency planning for visiting dignitaries.
The Healthy Environments and Consumer Safety strategic outcome seeks to improve health outcomes by:
- Reducing health and safety risks associated with tobacco consumption and the abuse of drugs, alcohol, and other controlled substances; and
- Reducing risks to health and safety, and improving protection against harm associated with workplace and environmental hazards, consumer products (including cosmetics), radiation-emitting devices, new chemical substances, and products of biotechnology.
A priority focus this year will be to help implement the Government's Environmental Agenda which responds to growing evidence that environmental factors contribute to health problems such as cancer, respiratory illnesses, and reproductive and developmental disorders. Initial action (programming and regulatory) is being undertaken on clean air and chemicals management.
Taking steps to modernize our regulatory frameworks and approaches is another important focus for Healthy Environments and Consumer Safety. This includes concrete initiatives such as modernizing the Hazardous Products Act, the Radiation Emitting Devices Act, and the Food and Drugs Act (Cosmetic Regulations) to protect the health of Canadians and implementing the International Health Regulations (2005) to help prevent the international spread of disease. Longer term efforts will identify the most efficient and cost-effective instruments to best reduce particular health risks facing Canadians.
A focus on human resources is also required to ensure we have the capacity needed to support key activities. Finding professionals with expertise in the applied sciences (e.g., toxicology, epidemiology, biology) and in both occupational and public health (e.g., nurses, medicine, psychologists, industrial hygienists) is proving to be a challenge. We must compete with other organizations to attract highly qualified scientists and health professionals. This will be especially challenging given that additional staff and expertise is required to deliver on new government environmental initiatives. To respond to human resources risks, we will initiate a multi-year people management plan focussed this year on implementing training and development, recruitment and succession planning/knowledge transfer.
Health Canada will continue to advance science and use strong evidence-based research to formulate our healthy and safe living promotion and harm prevention programs, policies and regulations. Our experts work closely with colleagues in the federal government and beyond (e.g., academia) in the areas of both research and development and related scientific activities. Anticipatory, applied and novel research provide the evidence of emerging health issues and contribute to the design and implementation of policies, regulations and legislation, as well as to decision making, aiming at protecting the health and safety of Canadians. In our role as a regulator, we extend our scientific research by contributing to the generation, dissemination and application of scientific and technological knowledge, including the assessment of products and processes for the purpose of regulation, as well as surveillance, testing and collection of information. In addition to our internal activities related to scientific research, health surveillance, and foresight in the safe use of emerging and merging technologies (such as biotechnology and nanotechnology), we will also use the science conducted by external organizations to help identify risks to human health, and assess and manage these risks.
Activities within this strategic outcome require sustained partnerships with other government departments as well as provinces and territories, non-governmental organizations, and the international community. We work closely with the Health Products and Food Branch, the Pest Management Regulatory Agency, Environment Canada, and others on health and environment issues. We are engaged in the Government's public safety and anti-terrorism initiatives and, in support of the work the Government is doing on tackling illegal drug use and associated crime, we are working with Justice Canada, Public Safety and Emergency Preparedness Canada, the Royal Canadian Mounted Police, and the Canada Border Services Agency. We also collaborate with provinces and territories through various committees to develop guidelines on issues such as tobacco cessation and safe drinking water, and to coordinate nuclear emergency preparedness activities. Our work with the international community allows us to better respond to domestic health and safety issues, meet Canadian obligations and commitments, share best practices, and promote Canadian leadership globally.
The contributions of regional offices are integral to program delivery. They include: playing a leadership role on key national initiatives; conducting inspection, surveillance and educational activities related to consumer products, tobacco, controlled drugs and substances; conducting risk assessments and evaluations; providing health advice to federal employees, provinces, and municipalities related to chemical contaminates and exposure levels, drinking water standards, and work environments.
Performance Measurement Strategy
| Expected Results | Performance Indicators |
|---|---|
| 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) |
see below |
Key Programs and Services
Two programmes carry out work aimed at reducing health and safety risks associated with tobacco consumption and the abuse of drugs, alcohol and other substances: the Drug Strategy and Controlled Substances Programme and the Tobacco Control Programme
| 2007-2008 | 2008-2009 | 2009-2010 | |||
|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs |
| 76.6 | 320 | 78.6 | 328 | 78.0 | 326 |
Key Initiatives
In partnership with key stakeholders and other levels of government, Health Canada will carry out the following key initiatives:
- Initiate the development of a national strategy to prevent the abuse of pharmaceutical products that are controlled substances, such as oxycodone and codeine.
- Develop and implement national alcohol drinking guidelines as per the recommendations of the National Alcohol Strategy.
- Implement the National Alcohol and Drug Use Monitoring Survey (CADUMS), which is an ongoing general population telephone based survey that will provide useful data on topical and emerging issues related to the use of alcohol and other drugs and substances in a timely, reliable, and continuous basis.
The Medical Marihuana Research Program objective was to fund clinical research on the therapeutic aspects of marihuana. The Program was terminated in 2006 as a result of ongoing expenditure review. The pharmaceutical industry and academic institutions will be relied upon to generate the information. This decision does not impact the two clinical studies currently underway that were approved under the Program, nor does it impact approved individuals access to marihuana for medical purposes (i.e. Marihuana Medical Access Regulations which came into effect on July 30, 2001).
| 2007-2008 | 2008-2009 | 2009-2010 | |||
|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs |
| 63.8 | 263 | 65.9 | 269 | 65.3 | 268 |
Key Initiatives
Research suggests that tobacco promotion at retail, in the form of multi-tiered displays of tobacco products covering walls and counter tops, may induce the use of tobacco products, particularly among youth. A key initiative will focus on protecting these people from inducements to smoke through the development of regulations to restrict the display at retail of tobacco products, branded accessories and signs on the availability and price of tobacco products.
| In support of the Federal Tobacco Control Strategy, Health Canada's BC regional office will fund community based projects that use innovative approaches to reach non-traditional target populations. One of these projects, entitled Smoke Screen, will provide educators, youth and community groups with documentaries and Learning Resource Packages that address tobacco use among immigrant youth and those who are learning English as a second language, while illuminating cultural attitudes and behaviours towards tobacco use. Another innovative project will aim to change the smoking culture of construction trades workers by targeting students who plan to work in those trades and by providing information to trades workers. Cessation resources will be disseminated through established trades networks such as WorkSafe BC and the BC and Yukon Trades Council. |
In addition, given the tobacco industry's stated intent to develop and market tobacco products with less toxins, toxicological testing of tobacco products and biomarkers of exposure to tobacco products (such as nicotine, exhaled carbon monoxide, tobacco-specific nitrosomines) will be undertaken. Harm reduction in terms of product modifications, their impact on smoking trends or behaviour, including questions on how to assess and regulate such products, represent an emerging area in science. We will explore innovative risk assessment methodologies to assess whether such modified tobacco products are more or less toxic than the range of products now on the market.
The five-year evaluation of the FTCS (2001-2006) demonstrates attributable health and economic benefits to Canadians of investments in tobacco control. The future FTCS will combine an on-going evaluation strategy built on its approved Results-based Management Accountability Framework in addition to cost-effectiveness studies and econometric modelling.
The signing of the World Health Organization sponsored Framework Convention on Tobacco Control is an opportunity to ensure that international policy and Canada's domestic policy are mutually reinforcing. Canada plays an active role in various working groups created by the Conference of the Parties, particularly those concerning the control of cross-border advertising and the regulation of the contents of tobacco products.
| In support of the Federal Tobacco Control Strategy, Ontario Region employees will work in collaboration with other federal departments, provincial and municipal governments as well as with non-government organizations including Aboriginal and Francophone communities, to improve the coordination, understanding and application of the Tobacco Act. Among the priorities for program delivery will be to improve coordination, efficiencies, effectiveness and delivery of inspection activities to protect the public against smoking health hazards in light of the 2005 Smoke-Free Ontario Act. |
Three programmes carry out work aimed at reducing risks to health and safety, and improved protection against harm associated with workplace and environmental hazards and consumer products (including cosmetics): the Safe Environments Programme, the Product Safety Programme, and the Workplace Health and Public Safety Programme.
| 2007-2008 | 2008-2009 | 2009-2010 | |||
|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs |
| 131.1 | 801 | 80.9 | 742 | 81.8 | 750 |
Key Initiatives
Health Canada, in collaboration with Environment Canada, is leading the development of Canada's new Chemicals Management Plan (CMP), one of two main themes of the Government of Canada's Environmental Agenda. The CMP will improve the degree of protection of Canadians and their environment against hazardous chemicals. The Plan will introduce a number of new, proactive measures that will ensure that risks are identified and assessed in a more effective and timely fashion, and that identified risks associated with chemical substances in or entering the marketplace are managed properly. Core activities under the CMP include research, risk assessment, risk management, and monitoring and surveillance.
The Canadian Environmental Protection Act is the most important statute for regulating toxic chemicals. Priorities include the development of an integrated science-based action plan across exposure media (food, air, soil, water, products) to reduce or eliminate the risks posed by hundreds of hazardous substances, and the investments needed to resolve the toxic legacy of the 20th century by 2020.
The second theme of the Environmental Agenda is a clean air agenda, which will improve risk management actions to address both indoor and outdoor air quality risks to health. Initiatives will target exposure and risk analyses for indoor and outdoor pollutants and for fuels and fuel additives, and provide guidance to research initiatives, in order to maximize the health benefits of regulatory and non-regulatory actions. Health Canada will continue to develop and implement the Air Quality Health Index, which will provide a daily measure of air pollution health impacts and will provide the public with means to make informed decisions to reduce exposure to health risks posed by smog.
| Health Canada will continue to work with Indian and Northern Affairs Canada and other experts as part of a national vapour intrusion working group to measure the extent of contaminant vapour intrusion such as low and high end volatile/non-volatile hydrocarbons (BTEX compounds: benzene, toluene, ethyl benzene, xylene; polycyclic aromatic hydrocarbons (PAHs)) into buildings under subarctic conditions. The goal of this effort is to test whether national guidelines are applicable to the subarctic conditions found in northern Manitoba and Saskatchewan and provide national guidance documents for remediation of contaminant site vapours. Data and recommendations will be shared with other regions having contaminated sites in the subarctic, as well as with the State of Alaska's contaminated sites program. A final report and recommendations for guidance documents will be issued in 2007. |
Under additional indoor initiatives, Health Canada will address risks associated with exposure to radon. Tools under development to provide accountability include the Air Health Indicator and the Air Quality Benefits Assessment Tool. The Air Health Indicator will assess how regulatory measures and other changes to outdoor air quality affect human health over time. The Air Quality Benefits Assessment Tool will quantify the health impacts of changes in air pollution and is used in cost/benefit analysis for regulatory and other risk management measures.
Health Canada will also increase awareness of climate change health risks and will complete and disseminate the Canadian Climate Change and Health Vulnerability Assessment in 2007, which assesses current and future vulnerabilities of Canadians and their communities to the health risks associated with climate change.
In keeping with an integrated source-to-tap approach to drinking water quality in Canada, Health Canada will establish and/or implement strategies to help address and prevent incidents of drinking water contamination across jurisdictions, including in small, rural, and remote communities. This includes building support for implementing a national Waterborne Contamination and Illness Response Protocol with federal departments, provinces and territories, as well as the launch and implementation of a web-based system designed to report boil water advisories and notify stakeholders across Canada.
| 2007-2008 | 2008-2009 | 2009-2010 | |||
|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs |
| 31.2 | 292 | 32.6 | 298 | 33.9 | 307 |
Key Initiatives
As part of the Government of Canada's new Chemicals Management Plan, Health Canada will: identify consumer products and cosmetics that may contain potentially harmful substances and develop strategies to best manage the risk associated with such products on the Canadian marketplace; develop regulations that appropriately identify and manage the potential risk that any new substance contained in Food and Drugs Act products (e.g., pharmaceuticals, personal care products, cosmetics) may pose to the environment and human health; and determine the risk to human health and the environment associated with environmental exposure to approximately 9,000 substances in products regulated under the Foods and Drugs Act that entered commerce in Canada between 1987 and 2001.
To be more responsive to present and future social and technological realities, Health Canada will be modernizing federal health protection legislation, specifically the Hazardous Products Act, Radiation Emitting Devices Act, and the Food and Drugs Act (Cosmetic Regulations). This will provide the Department with the necessary tools to better protect the health of Canadians, and to respond to the challenges of the global marketplace. Health Canada is committed to serving Canadians by strengthening its position as a nationally recognized and world-class regulator by establishing renewed legislative and regulatory frameworks.
Involvement on the international front will include work related to the Globally Harmonized System of Classification and Labelling of Chemicals (GHS) to enhance protection of human health and the environment. The GHS harmonizes chemical hazard classification and communication and is viewed globally as the basis for the sound management of chemicals. Health Canada will continue to work toward the legislative and regulatory changes necessary to implement the GHS as soon as possible.
In support of the Government's commitment to the health of children, Health Canada will continue with the implementation of the Lead Risk Reduction Strategy (LRRS) for Consumer Products. These measures will protect the health of Canadians by reducing health risks related to lead exposure, especially among infants and children. The LRRS proposes maximum lead content limits for four categories of consumer products with which children are likely to interact. Regulations for each category will be developed separately. We will also continue monitoring the compliance rates for products already regulated for lead content.
| 2007-2008 | 2008-2009 | 2009-2010 | |||
|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs |
| 31.1 | 398 | 31.8 | 397 | 32.7 | 395 |
Key Initiatives
Health Canada is working closely with the Public Health Agency of Canada (PHAC) and the World Health Organization to increase international cooperation efforts and to ensure compliance with the International Health Regulations (2005), the purpose of these are to prevent, protect against, control, and provide a public health response to the international spread of disease and avoid unnecessary interference with international traffic and trade. In doing so, both Health Canada and PHAC are collaborating with the Canada Border Services Agency, Transport Canada, the Canadian Food Inspection Agency, the Royal Canadian Mounted Police, Environment Canada, Fisheries and Oceans Canada, and others as appropriate.
| 2007-2008 | 2008-2009 | 2009-2010 | |||
|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs |
| 31.1 | 398 | 31.8 | 397 | 32.7 | 395 |
Program Activity Description
Health Canada's Pest Management Regulatory Agency (PMRA) protects human health and the environment by minimizing the risks associated with pest control products in an open and transparent manner, while enabling access to these pest management tools and sustainable pest management strategies. The PMRA registers pesticides and provides advice on sustainable pest management strategies. The Agency considers environmental and human health risks associated with proposed products as well as product effectiveness and contribution to sustainable development. As well, the PMRA sets maximum residue limits (MRLs) under the Food and Drugs Act. The Pest Control Products Act (PCPA) and Regulations allow the Agency to meet these commitments while providing access to Canadian and global pest management tools.
This year, along with our core work, the Agency's priorities will be the continued implementation of the new PCPA by advancing work on regulatory priorities such as Incident and Sales reporting and our commitment to transparency, access to new products including reduced risk and new uses in Canada by utilizing performance standards in review work and addressing the technology gap and, finally, re-evaluation and full life-cycle management within the new PCPA and the Chemical Management Plan.
Science is the foundation for Health Canada's activities related to Pest Control Product Regulations. We conduct assessments of risks to human health and the environment arising from exposure to chemical and biological pesticides as well as assessments of the value of these products. In support of this work, we develop assessment methodologies, pesticide testing protocols, risk reduction strategies and risk management tools. Scientific expertise is in place in the following areas: toxicology, environmental toxicology, analytical chemistry, environmental fate and chemistry, biochemistry, endocrinology, ecology, crop science, plant pathology, entomology, occupational and bystander assessment, and aggregate and cumulative assessment.
To meet the Agency's objectives, we will collaborate with experts in a variety of disciplines throughout the Health Portfolio and with the five natural resource departments (Environment Canada, Fisheries and Oceans Canada, Natural Resources Canada, the Canadian Food Inspection Agency and Agriculture and Agri-Food Canada). This year the Agency will be collaborating with others in Health Canada and Environment Canada to implement the new Chemicals Management Plan that improves the degree of protection for Canadians and their environment against hazardous chemicals in products they use, food and water they consume and environments in which they live. We will work with Healthy Environments & Consumer Safety (HECS) Branch to facilitate the exchange of review material on compounds that have shared jurisdiction under both programs. We will also work with HECS and the Public Health Agency of Canada (PHAC) to provide technical support to the Department of National Defence in a fact-finding exercise on the use of registered herbicides and testing of military chemicals at CFB Gagetown, in partnership with Veterans Affairs Canada and other federal departments. Health Canada's PMRA also participates in a number of departmental working groups that are developing or updating various science-based methodologies for risk assessment.
We also work with the Canadian Food Inspection Agency (CFIA) on their priority setting exercise to set their annual inspection and monitoring program, and with the CFIA and provincial governments on compliance activities; and with Agriculture and Agri-Food Canada to develop risk reduction strategies and improve access to specialized pest control.
We rely on professionals in a number of scientific disciplines to achieve our key results for Canadians. The PMRA must compete with other organizations to attract and retain highly qualified professionals. To address this risk we will focus on recruitment, retention, learning and succession planning through our human resources plan in order to ensure we have the human resources to support our activities under this strategic outcome.
The expected result of this program activity "To protect human health and the environment by minimizing risks associated with pesticides imported, sold or used in Canada" is supported by four main program sub activities: New Pest Control Product Registration and Decision-Making; Registered Pest Control Product Evaluation and Decision Making; Compliance; and Pesticide Risk Reduction. The table above outlines the planned resources allocated for this program's activities.
New Pest Control Product Registration
New pesticides undergo an extensive pre-market assessment by Health Canada to ensure their use poses no unacceptable risks. This includes an assessment of human health risk (including worker and bystander exposure), food residues, environmental risk (including environmental fate and potential effects on wildlife), and an assessment of value. Assessments are carried out using the most modern scientific methods available and meet international best practices.
To provide for continual updating of regulatory approaches, we are working closely with the United States and Mexico through NAFTA and with OECD countries globally through the OECD Working Group on Pesticides. This work is focussed on harmonization, joint reviews, and worksharing to ensure pesticide risk assessments are efficient and benefit from the best science available internationally. In 2007-2008, Health Canada is committed to using joint review and worksharing opportunities to assist both in closing the technology gap that exists between Canada and the United States and to expand our current joint review program with the United States into global worksharing arrangements with other OECD countries for the assessment of pesticides.
Registered Pest Control Product Evaluation
We re-evaluate older pesticides currently on the market to determine if their continued use is acceptable in consideration of modern scientific approaches. Significant public consultation is undertaken on risk assessments and risk management proposals to engage stakeholders, including registrants, other government departments, growers and their associations, other non-governmental organizations, as well as the general public.
We will continue to implement risk mitigation measures where required to address concerns regarding risks that could emerge during the re-evaluation of a chemical. As required, under the Pest Control Products Act, we will continue to work with the Environmental Protection Agency in the United States on a proposed approach to re-evaluation and develop a plan to work cooperatively on future re-evaluations.
National Pesticide Compliance Program
Health Canada promotes, monitors and enforces compliance with the Pest Control Products Act and Regulations principally through the National Pesticide Compliance Program (NPCP). Where non-compliance is detected, we apply the appropriate enforcement (e.g., education, monetary penalties or prosecution).The NPCP includes programs that address both regional and national compliance and enforcement problems and issues. Much of this work is accomplished through a regional network of designated officials who inspect and investigate those who manufacture, distribute and use pesticides. An example of a compliance activity is marketplace inspections.
In addition, we will continue to work in partnership with provincial and other federal regulators and will explore further opportunities for coordination and collaboration with international organizations, e.g., US EPA. Specifically, in 2007-2008 Health Canada will finalize its work on performance indicators for the compliance area. As well, the partnership agreement with CFIA for NPCP program delivery will be renewed.
Pesticide Risk Reduction in Agriculture and Other Sectors
The Pesticide Risk Reduction Program supports the objectives of the new Pest Control Products Act to facilitate access to reduced risk products and enhance sustainability in agriculture. It is a grower led, commodity-based program that is jointly facilitated by the Sustainable Pest Management Section of the Pest Management Regulatory Agency and the Pest Management Centre of Agriculture and Agri-Food Canada (AAFC). The goal of the program is to improve the sustainability of Canadian agricultural commodities through the development and implementation of commodity-based risk reduction strategies. Benefits resulting from this program will include the development and adoption of alternative pest management practices through applied research into reduced risk alternative tools and biopesticides.
Health Canada and AAFC will continue working with stakeholders to develop commodity-specific pesticide strategies for the initial twenty priority crops including apples, potatoes, dry beans, soybeans and greenhouse vegetables. In addition, stakeholder consultations will be held for two new commodities, namely blueberry (highbush and lowbush) and raspberry, and crop profiles will be developed for three new commodities (broccoli, cabbage and cauliflower). Active stakeholder participation in building and implementing strategies is critical to the success of the program.
Performance Measurement Strategy
| Expected Results | Performance Indicators |
|---|---|
| Access to safer pesticides Improved transparency and knowledge dissemination |
Number of new reduced risk ingredients available for use in Canada Percentage of reduced risk chemicals & percentage of biopesticide active ingredients registered/pending registration in the U.S. that are registered/pending registration in Canada Number and type of regulatory proposals /directives / policies published in 2007-2008 |
Web Links
Pest Management Regulatory Agency (PMRA) home page:
www.pmra-arla.gc.ca
PMRA Strategic Plan 2003-2008
www.pmra-arla.gc.ca/english/pdf/plansandreports/pmra_strategicplan2003-2008-e.pdf
Strategic Outcome: Better Health Outcomes and Reduction of Health Inequalities Between First Nations and Inuit and Other Canadians.
| Program Activity - First Nations and Inuit Health | ||||
|---|---|---|---|---|
| Planned Spending and Full-Time Equivalents (FTEs) | ||||
| ($ millions) | Forecast Spending 2006-2007 |
Planned Spending 2007-2008 |
Planned Spending 2008-2009 |
Planned Spending 2009-2010 |
| Gross Expenditures Less: Expected respendable revenues |
2,125.6 5.5 |
2,136.3 5.4 |
2,153.9 5.4 |
2,194.2 5.4 |
| Net Expenditures | 2,120.2 | 2,130.9 | 2,148.5 | 2,188.8 |
| FTEs | 2,881 | 2,843 | 2,822 | 2,822 |
| Notes: The increase in forecast/planned expenditures from 2006-2007 to 2007-2008 is mainly due to the yearly growth of the Indian Envelope and an increase in the funding level for the Follow-Up to the Special Meeting of First Ministers and Aboriginal Leaders (September 12, 2004). This increase is partially offset by the
Budget 2005 Expenditure Review Committee (ERC) reduction. The increase in planned expenditures from 2007-2008 to 2008-2009 is mainly due to the yearly growth of the Indian Envelope. This increase is paritally offset by the sunset of funding for the implementation of the First Nations Water Management Systems Initiative. The increase in planned expenditures from 2008-2009 to 2009-2010 is mainly due to the yearly gowth of the Indian Envelope. The change in Revenue is due to rounding the amounts to millions of dollars. Figures include an amount for departmental and regional infrastructure costs supporting program delivery. |
||||
Program Activity Description
The objectives of Health Canada's First Nations and Inuit health program activity are to improve health outcomes, ensure the availability of and access to quality health services, and support greater control of the health system by First Nations and Inuit.
In pursuing these goals, the Department must face many of the same challenges as other Canadian health providers such as an aging population, health human resource shortages, rising costs of drugs, and the demand for new health care technologies. This has increased the challenges to health care sustainability in both the federal and provincial and territorial health systems. The First Nations and Inuit health system is also subject to additional pressures due to a faster growing population, higher than average rates of injuries, higher overall disease burden, rural and remote populations, and a unique set of programs and services.
Health Canada works closely with our health partners and other federal departments to respond to these challenges and meet these goals. We support the Public Health Agency of Canada in its delivery of Children and Youth programming through the Aboriginal Head Start in Urban and Northern Communities program as well as its work on a number of pan-Aboriginal programs and pandemic planning activities. In addition, we work closely with Indian and Northern Affairs Canada through: the First Nations Water Management Strategy, to ensure that all First Nations communities across Canada have access to a safe and reliable water supply; the Home and Community Care program, to address the gaps in continuing care services available to First Nations and Inuit communities; and the Labrador Innu Comprehensive Healing Strategy, to support long term healing in the Labrador Innu communities. We also work with Indian Residential Schools Resolution Canada to ensure that eligible former students of Indian residential schools have access to mental health and emotional supports.
Health Canada will focus on four key priority areas in 2007-2008:
1) continuing to provide health-related programs and services;
2) improving quality of and access to health-related programs and services;
3) promoting healthy living and disease prevention; and
4) improving accountability and performance measurement.
Continuing to Provide Health-Related Programs and Services
Health Canada provides a range of First Nations and Inuit health programs and services that will continue into 2007-2008. In partnership with First Nations and Inuit, we will continue to provide primary care services in approximately 200 remote communities, and home and community care in over 600 communities. Health Canada employs approximately 665 nurses to deliver health services to communities, and maintains nursing stations, community health centres and other health service facilities. In addition, health services are provided by nursing staff and other health care workers directly employed by communities through health service transfer agreements and contribution agreements with Health Canada.
| Through strengthened working relationships between Health Canada, the Government of Nunavut and the Nunavut Tunngavik Incorporation, the Nunavut HII project resulted in an action plan outlining a model for Integrated Service Delivery in Nunavut which identifies a number of possible short, medium and long term activities. Projects are now being developed such as the development of a continuum of culturally relevant mental health and addictions services and a supporting Community Wellness approach. |
Through our regional offices, the Department will continue to provide programs and services focussed on children and youth, mental health and addictions, chronic diseases, environmental health, and communicable and non-communicable disease prevention. These services supplement and support the services that provincial, territorial and regional health authorities provide. For example, the First Nations and Inuit Home and Community Care program will continue to support the delivery of quality home and community-based services to support those with chronic diseases, persons with disabilities and the elderly in over 640 communities. Through the Non-Insured Health Benefits Program, drugs, dental care, vision care, medical supplies and equipment, short-term crisis intervention, mental health services, and medical transportation will continue to be available to all 780,000 registered Indians and recognized Inuit in Canada, regardless of residency.
| The Alberta Region will further use information for action in advancing positive health outcomes for First Nations persons and communities through the use of enhanced health surveillance systems. These new and innovative systems include a Datacube project which furnishes a suite of tools to support the interactive, multidimensional analysis of Health Surveillance data obtained from multiple sources/channels. In addition, a Geographic Information System (GIS) developed in the region allows for the mapping of a broad range of surveillance and environmental health data by GPS coordinates, enabling and facilitating user friendly access to information as presented by provincial geographic location. Such data provides health researchers and practitioners with credible data from which evidenced based health policy, program and service delivery decisions may be made. |
Improving Quality and Access to Health-related Programs and Services
The Department continues to experience challenges in recruiting nurses into First Nations and Inuit communities, especially for facilities located in remote and isolated areas. Health Canada is particularly concerned with the impact that nursing shortages have on the provision of services and the health and well-being of First Nations and Inuit. We will work closely with our National Aboriginal and Nursing partners to address issues affecting the recruitment and retention of nurses in First Nations and Inuit communities and to ensure that nurses have the clinical expertise and supports needed to provide primary health care in communities.
| The development and implementation of Projet ACCES in the Quebec region is a priority for the First Nations and Inuit Health Branch (FNIHB). The main objective of this project is to facilitate access to our services and bring them closer to clients, in response to a request made by the First Nations and Inuit communities. It will allow us to put in place a co-ordination mechanism for FNIHB program and service delivery and will lead to improved client service, with a view to better health outcomes and better First Nations and Inuit control in their assumption of responsibility for their health services. |
To increase the long-term supply of First Nations, Inuit and Métis health care providers, the Department will increase the amount of funding available through bursaries and scholarship initiatives to help support more First Nations, Inuit and Métis students who pursue health care studies. In addition, more bridging, access and student support programs for Aboriginal health care students will be supported at post-secondary institutions. In partnership with professional associations, we will facilitate the adaptation of medical, nursing and other health care curricula to increase the cultural awareness of doctors, nurses and others providing health services to First Nations, Inuit and Metis patients. We will also work with Indian and Northern Affairs Canada and our provincial partners to ensure that math and science courses are better oriented to First Nations and Inuit students, thereby enhancing the likelihood of success in health careers.
We will work with our partners to support the development and implementation of quality improvement activities, including accreditation of Aboriginal health organizations. This involves measuring the organization's health services delivery against a consistent set of national standards of excellence. The focus will continue to be on enhancing the cultural elements and system supports of Aboriginal accreditation, with the goal of increasing the number of Aboriginal healthcare organizations engaged in the accreditation process by 30% to over 70 organizations in total.
Through the establishment of Patient Wait Times Guarantees (PWTGs) pilot projects, Health Canada will improve access to its health services delivered to First Nations on reserve. The pilot projects are expected to last approximately two years, and will include an evaluation to determine the effectiveness of the PWTG and its potential to be applied to additional First Nations communities.
| We will continue to work to improve access to health services for all Aboriginal peoples through the implementation of the Aboriginal Health Transition Fund, which supports better integration of federal, provincial and territorial health programs and services to First Nations and Inuit and the adaptation of provincial and territorial health services to respond to the needs of First Nations, Inuit and Métis. It is expected that this work will contribute to the development and implementation of longer-term bilateral and/or multipartite agreements to address Aboriginal health issues of mutual concern, such as the tripartite implementation plan currently being negotiated with British Columbia First Nations and the British Columbia provincial government. |
We will continue to provide services under the Children's Oral Health Initiative in over 100 communities to improve the oral health of First Nations children on-reserve. In addition, a new oral health information system will be implemented to collect data on the effectiveness of the Children's Oral Health Initiative.
Health Canada supports the construction, operation, maintenance and environmental management of on-reserve health facilities and staff residences. In 2007-2008, eighteen health facilities will be constructed or expanded, and recapitalization initiatives (repairs, replacements, upgrades) will improve the working environment of clients and staff, and enhance the
quality
of health care services offered at the community level. We will also invest $1.5 million in environmental audits, assessments and remediation to ensure operations of health facilities in First Nations communities meet environmental codes and requirements and are consistent with the Department's commitments to sustainable development.
Promoting Healthy Living and Disease Prevention
The Department will work with National Aboriginal Organizations to implement the Maternal Child Health Program for pregnant First Nations women and families with infants and young children living on-reserve. The program will provide home visits by both nurses and trained, experienced mothers in the community as well as case management for families living with more complex needs. In the North, including the territories, Nunavik and Nunatsiavut, program funding will enhance health promotion programs already in place such as the Canada Prenatal Nutrition Program and the Fetal Alcohol Spectrum Disorder Program and complement the health services provided by the province or territory.
In 2007-2008, First Nations and Inuit Health, Ontario Region (FNIH, OR) will work with the Chiefs of Ontario on an initiative to develop a comprehensive, seamless Public Health System for First Nations Communities. The initiative has two main elements. The first is to clarify relationships and roles among First Nations, FNIH, OR and provincial public health organizations. The second is to design, develop and implement a First Nations Component of the Public Health Management and Surveillance System that will be aligned with Ontario's public health surveillance system.
We will continue to expand the Aboriginal Head Start On Reserve Program by addressing the need for more training and facilities to deliver services. The Department will create more Program spaces and sites and engage in capacity building activities to further professional development for workers. In addition, outreach will be strengthened and expanded to serve small communities that do not have enough children to run a centre-based program, through increased investments in staff training for those workers who deliver the Program in a home setting and funding for new projects in small communities. These investments will allow the Department to reach more children and improve the current community-based projects that already exist.
Health Canada will also continue to implement the National Aboriginal Youth Suicide Prevention Strategy
(NAYSPS). Although there is variation among First Nations communities, overall suicide rates are 5 to
7 times more than the rate for Canadian youth. Suicide rates among Inuit youth are up to 11 times higher than the national average. Actual rates among Aboriginal youth living off reserve and in urban centres, including Métis and urban Inuit, are not well established. In 2007-2008, approximately 75-100 First Nations and Inuit communities will carry out their suicide
prevention plans. These plans will focus on prevention, skills training, and the development of protocols to respond to suicide-related crises. Moreover, the Strategy will support awareness and knowledge raising activities to promote mental wellness and resiliency among youth. The Strategy will also continue to increase what we know about what works best to prevent
Aboriginal youth suicide, and how suicide impacts Aboriginal youth living off reserve and in urban areas, through evaluation, data gathering and research.
Health Canada is working with key partners to develop a strategic action plan for First Nations and Inuit mental wellness. The objective of the plan is to improve the mental wellness of First Nations and Inuit through a coordinated continuum of mental health and addictions services that respect traditional, cultural and mainstream approaches to healing. Over the next 3-5 years, we will work with Aboriginal organizations and provinces and territories to implement key aspects of this plan that can proceed within existing resource levels, such as raising awareness of the strategic action plan and its objectives and aligning existing programs with the plan. The Department will also continue to offer a continuum of mental health and emotional support services to former students of residential schools and their families.
The prevalence of diabetes is 3-5 times higher in the Aboriginal population compared to the general population. Addressing the high rates of chronic disease, such as diabetes, within the Aboriginal community is a key focus for the Department and we will continue with the enhancement of the Aboriginal Diabetes Initiative. This will strengthen community-based diabetes prevention and promotion activities, increase the number and training of service providers and improve screening and care services. Participatory research will be undertaken to gather more data on pre-diabetes, diabetes and its complications, and to develop strategies to reduce the burden of the disease. Complementary activities to aid in diabetes prevention will also be implemented. This includes the launch and implementation of a food guide for First Nations, Inuit, and Metis based on the revised Canada's Food Guide, and partnerships with retailers in northern isolated communities to support healthy eating by increasing availability, quality and promotion of healthy foods.
We will continue to support the development of communicable disease emergencies plans including pandemic influenza planning. Efforts will be focused on increasing emergency planning and response capacity at the regional and community levels, strengthening collaborative relationships with provinces and territories, and ensuring that emergency supplies are readily available to on-reserve health centres in First Nations and Inuit communities.
| In BC Region, planning and preparation will continue to take place to minimize the impact of an influenza pandemic on First Nations communities. An inventory of First Nations emergency preparedness plans will be completed and an emergency preparedness coordinator will be in place to work with First Nations. Health Canada will work with First Nations to increase the number of communities that have completed pandemic plans and have conducted table-top exercises, with a target of 80% completion by 2009. |
We will conduct research and provide funding for the National First Nations Environmental Contaminants Program and the Northern Contaminants Program. We will support five large National First Nations projects that focus on investigating the effects of environmental contaminants on First Nations reserves. We will also fund four projects through the Northern Contaminants Program to increase the knowledge of First Nations and Inuit about the extent of environmental contaminants exposure in their communities as well as to increase capacity of First Nations communities to manage environmental health research projects.
We will also conduct an Environmental Contaminants Traditional Food Safety Workshop that will bring together representatives of First Nations communities across Saskatchewan to discuss nutritional benefits of traditional foods and environmental health risks associated with consuming traditional foods. This will increase knowledge of the benefits and risks of various food choices, for better decision making.
In partnership with Indian and Northern Affairs Canada, and with Canada Mortgage and Housing Corporation (CMHC) and the Assembly of First Nations, Health Canada is working towards developing greater capacity among First Nations and their organizations to prevent and remediate mould problems and improve housing conditions in their communities. Health Canada will also work with CMHC to ensure that education and training materials cover both the public health and construction aspects of quality housing.
Through the First Nations Water Management Strategy, the Department will develop products that will put a greater focus on preventative activities and develop clear and consistent procedures to address waterborne threats to human health in First Nations communities.
Improving Accountability and Performance Measurement
We will undertake efforts to improve health surveillance and information analysis, including data development, data analysis, research evidence to support priority-setting and decision-making on health related investments. For example, through the Aboriginal Diabetes Initiative, we will develop a research agenda and identify research priorities that will inform future diabetes programming.
Health Canada also draws information from evaluation and review studies to support program improvement. In 2007-2008, we will initiate three integrated program cluster level evaluations for the Children and Youth, Environmental Health and Research and Communicable Disease Control program areas. The Department will also finalize the joint evaluation with Indian and Northern Affairs Canada on the First Nations Water Management Strategy.
Performance Measurement Strategy
The First Nations and Inuit Health program has established expected results and indicators to assess progress towards the achievement of the strategic outcome. Use of the information below will contribute to providing a snapshot of the health status of First Nations and Inuit.
| Expected Results | Performance Indicators |
|---|---|
| Better health outcomes and reduction of health inequalities between First Nations and Inuit and other Canadians | Life expectancy (at birth, on and off reserve) Birth weight NIHB client utilization rates |
Key Programs and Services
The following describes seven key program areas that Health Canada will continue to be engaged in throughout 2007-2008: children and youth; mental health and addictions; chronic disease and injury prevention; environmental health and research; communicable disease control; primary care; and non-insured health benefits.
| 2007-2008 | 2008-2009 | 2009-2010 | ||||
|---|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs | |
| 109.7 | 7.1 | 114.7 | 7.3 | 114.9 | 7.4 | |
| 2007-2008 | 2008-2009 | 2009-2010 | ||||
|---|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs | |
| 125.0 | 3.1 | 121.4 | 3.1 | 110.0 | 3.1 | |
| 2007-2008 | 2008-2009 | 2009-2010 | ||||
|---|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs | |
| 46.1 | 3.2 | 51.6 | 3.2 | 61.4 | 3.2 | |
| 2007-2008 | 2008-2009 | 2009-2010 | ||||
|---|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs | |
| 44.4 | 10.2 | 44.2 | 10.2 | 18.3 | 10.2 | |
| 2007-2008 | 2008-2009 | 2009-2010 | ||||
|---|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs | |
| 25.2 | 6.8 | 26.2 | 6.8 | 26.2 | 6.8 | |
| 2007-2008 | 2008-2009 | 2009-2010 | ||||
|---|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs | |
| 235.5 | 64.7 | 233.7 | 66.6 | 237.8 | 68.6 | |
| 2007-2008 | 2008-2009 | 2009-2010 | ||||
|---|---|---|---|---|---|---|
| $ (in millions) | FTEs | $ (in millions) | FTEs | $ (in millions) | FTEs | |
| 888.7 | 20.8 | 908.4 | 4.4 | 928.8 | 22.0 | |
First Nations and Inuit Programs and Services and web links
Other programs and services that contribute to this program activity total $656.3 million; for more information on those programs and services please see the following links:
Non-Insured Health Benefits 2004/05 Annual Report:
http://www.hc-sc.gc.ca/fnih-spni/pubs/nihb-ssna/2005_rpt/index-eng.html
Non-insured health Benefits Program
http://www.hc-sc.gc.ca/fnih-spni/nihb-ssna/index-eng.html
http://www.hc-sc.gc.ca/fnih-spni/nihb-ssna/index-fra.html
Aboriginal Head Start On Reserve
http://www.hc-sc.gc.ca/fnih-spni/famil/develop/ahsor-papa_intro-eng.html
http://www.hc-sc.gc.ca/fnih-spni/famil/develop/ahsor-papa_intro-fra.html
Fetal Alcohol Spectrum Disorder
http://www.hc-sc.gc.ca/fnih-spni/famil/preg-gros/intro-eng.html
http://www.hc-sc.gc.ca/fnih-spni/famil/preg-gros/intro-fra.html
Aboriginal Diabetes Initiative
http://www.hc-sc.gc.ca/fnih-spni/diseases-maladies/diabete/index-eng.html
http://www.hc-sc.gc.ca/fnih-spni/diseases-maladies/diabete/index-fra.html
Injury Prevention
http://www.hc-sc.gc.ca/fnih-spni/promotion/injury-bless/index-eng.html
http://www.hc-sc.gc.ca/fnih-spni/promotion/injury-bless/index-fra.html
Indian Residential Schools Resolution Health Support Program
http://www.hc-sc.gc.ca/fnih-spni/services/indiresident/index-eng.html
http://www.hc-sc.gc.ca/fnih-spni/services/indiresident/index-fra.html
National Native Alcohol and Drug Abuse Program
http://www.hc-sc.gc.ca/fnih-spni/substan/ads/nnadap-pnlaada-eng.html
http://www.hc-sc.gc.ca/fnih-spni/substan/ads/nnadap-pnlaada-fra.html
Communicable Disease Control
http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/phcphd-dsspsp/cdcd-dcmt/index-eng.html
http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/phcphd-dsspsp/cdcd-dcmt/index-fra.html
Environmental Health
http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/phcphd-dsspsp/ehd-dse/index-eng.html
http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/phcphd-dsspsp/ehd-dse/index-fra.html
Drinking Water Quality
http://www.hc-sc.gc.ca/fnih-spni/promotion/water-eau/index-eng.html
http://www.hc-sc.gc.ca/fnih-spni/promotion/water-eau/index-fra.html
Immunization Schedule for Infants and Children
http://www.phac-aspc.gc.ca/im/is-cv/index.html
http://www.phac-aspc.gc.ca/im/is-cv/index-fra.html
Targeted Immunization (TIS) Program
http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni/immuni-eng.html
http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni/immuni-fra.html
e-Health
http://www.hc-sc.gc.ca/fnih-spni/services/ehealth-esante/index-eng.html
http://www.hc-sc.gc.ca/fnih-spni/services/ehealth-esante/index-fra.html
Aboriginal Health Human Resources Initiative
http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni/ahhri-irrhs-eng.html
http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni/ahhri-irrhs-fra.html
