Canada's Performance 2002

About Canada's Performance 2002

This document is the President of the Treasury Board's eighth annual report to Parliament on government performance. Previous reports are available at:
http://www.tbs-sct.gc.ca/est-pre/estime.asp.

Canada's Performance 2002 provides information on the quality of life of Canadians, as measured by certain societal indicators. In so doing, it sets a context for assessing the performance of federal government programs. It also provides basic information to support dialogue among Canadians about future directions in public policy.

How to Get More Information

The electronic version of this report includes many links to additional information on the societal indicators discussed in this report, as well as to information on the plans and performance of federal departments and agencies. If you would like further information or would like to make comments on or suggestions regarding Canada's Performance 2002, please contact

Treasury Board of Canada Secretariat
Results Based Management
300 Laurier Avenue West
9^th Floor, West Tower
Ottawa, Ontario K1A 0R5

Telephone: (613) 957-7183
Facsimile: (613) 957-7044
E-mail: RMA-MRR@tbs-sct.gc.ca

President's Message

In Canada, the enduring priority of the government is to improve the quality of life of Canadians-building a world-leading economy, ensuring a clean environment, promoting the health of our citizens and improving the strength and safety of our communities. Our goal is to make Canada a land of ever-widening opportunity, where the benefits of the new economy touch every community and lift every family and every Canadian.

The government also believes that a healthy democracy, such as Canada's, requires the active engagement of its citizens in understanding the economic and social issues we face as a nation. That is why we are publishing Canada's Performance 2002, a report on the quality of life in Canada and how the actions of the government contribute to improving our well-being.

The Government of Canada, however, is not working alone. Individuals, families, voluntary organizations, private-sector firms and other levels of government all contribute to Canada's social and economic achievements. The government will continue to work in partnership with these participants in Canadian society in pursuit of a higher quality of life for all.

Canada's Performance 2002 highlights both Canada's strengths and areas in which we can do better. It points out our successes in health and economic performance, particularly employment, and indicates the challenges we continue to face in areas such as improving the environment and encouraging a more involved civic society.

The information contained in this report serves a threefold purpose. It helps to encourage active citizen engagement in public policy debates. It provides a government-wide perspective from which to view the results reported by individual federal departments and agencies in their fall performance reports. Last but not least, it promotes a modern management regime focussed on results by encouraging departments and agencies to link their objectives and achievements to improvements in the quality of life of Canadians.

Canada is the only country to publish such a report and is a world leader in promoting transparency, accountability and results as the foundation of modern government. Therefore, it gives me great pleasure to present this insightful look at our quality of life in the year 2002 and the efforts of the government to build the Canada we want for ourselves and future generations.

"The paper version was signed by Lucienne Robillard, President of the Treasury Board"

Lucienne Robillard
President of the Treasury Board

Introduction

The Canadian Way in the 21st Century

Countries around the world are grappling with how best to secure economic prosperity in a globalized society while at the same time ensuring that no member of their society is left behind. Canada has developed a distinctive approach to this challenge, one that has been referred to as the Canadian Way. It is an approach marked by an accommodation of cultures, a recognition of diversity, a partnership between citizens and the state, a sharing of risks and benefits, and a positioning of government as an instrument of collective action. It is an approach centred on a goal that is common to all Canadians - improving quality of life for all.

This is a report on how Canada is progressing toward that goal. It provides information on the quality of life in our country and where we stand in comparison with other post-industrial nations. With this information, Canadians can better assess the performance of the Government of Canada and more fully engage in shaping public policy.

Canada's Performance 2002 is linked to the Government of Canada's efforts to govern well and in a manner that responds to the challenges that all governments are currently facing. Governments around the world, for instance, are dealing with the challenges posed by the knowledge age. A move from an industrial to a global knowledge economy and its accompanying advances in information technologies means that government and its institutions must adapt. The Government of Canada's response to this challenge has been, among other things, to encourage the development of a Public Service that is modelled on the principles of a dynamic learning organization, rather than those of an internal process-oriented bureaucracy. The government wants a Public Service that is able to innovate and to constantly explore new and better ways of serving Canadians.

The governments of advanced democracies are also dealing with a global shift in values, wherein citizens are more demanding of governments and want a stronger voice in decision making. The federal government is meeting this challenge head-on by rebuilding public trust in institutions. This means that government must be more transparent and accountable. Rebuilding trust also means that the ethics and integrity of the Public Service must be supported and encouraged.

There are also increasingly complex interactions of actors on the political stage. Different levels of government, non-governmental organizations, and the voluntary and private sectors all play a role in policy and service delivery decisions. As a result, the Government of Canada realizes that it must undertake its efforts in collaboration with partners.

And finally, as a result of all of the factors mentioned above, governments are attempting to manage in a more modern way. The federal government's modern management agenda is clear. It is delineated in Results for Canadians: A Management Framework for the Government of Canada and it entails four fundamental commitments: to begin with a citizen focus in designing, delivering, evaluating and reporting on government activities; to guide public service management by a clear set of values, including openness and transparency; to focus on the achievement of results; and to ensure responsible spending.

Canada's Performance 2002 has three simple objectives that align with many of the modern governance principles noted above:

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• Building trust and encouraging citizen engagement: The report informs Canadians about the country's social and economic situation - as well as about some of the public policy issues raised by it. Informing Canadians in this way will pave the way for increased engagement in public policy debates, whether through government-led consultations or through active personal participation in policy formulation.
   
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• Transparency and accountability to parliamentarians: Each year since 1997 the government has tabled two sets of departmental reports in Parliament. In the spring, departments and agencies produce their Reports on Plans and Priorities for the coming fiscal year. In the fall, they provide parliamentarians with their Departmental Performance Reports indicating achievements attained over the previous fiscal year. Canada's Performance 2002 provides a context in which to review the results reported by individual federal departments and agencies in fall performance reports. This whole-of-government perspective provides parliamentarians and citizens with an improved means to engage on budget and program matters.
   
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• The encouragement of a modern management regime focussed on results: The report encourages departments and agencies to clearly link their objectives and achievements to improvements in the quality of life of Canadians.

What's in the Report

What's New

This is the second year that the government has used societal indicators to provide a context for its performance. Some of the major improvements since last year's report include the following:

• the addition of a "Performance Highlights" section, which summarizes Canada's performance over the last 5 to 10 years in each of the areas covered in the report;
• the inclusion, at the end of each chapter, of performance information at the level of departmental results, rather than at the program level - this allows Canada's Performance 2002 to link up to the departmental reports on plans and on performance more easily; and
• enhanced access to more detailed levels of performance information in the electronic version.

Partnering for Success

Canada's Performance 2002 measures progress towards broad societal goals. Many factors beyond the direct control of the federal government influence progress on the 19 indicators tracked in this report. Individuals, families, voluntary organizations, private-sector firms, governments and other participants in Canadian society all contribute to the quality of life of Canadians. And, indeed, we live in a global village where activities outside our country have a large influence on our well-being. The Government of Canada is one of many players taking actions that influence the broad social and economic outcomes described in this report. The government is committed to working with our partners in pursuit of a higher quality of life for Canadians. Following are just a few examples in which the federal government is working strategically with partners to achieve shared goals - information on similar partnerships is available on-line at the government's "Horizontal Results Database" at http://www.tbs-sct.gc.ca/rma/eppi-ibdrp/hrdb-rhbd/profil_e.asp:

• The Social Union Framework Agreement (SUFA): Signed in 1999 by federal, provincial, and territorial governments (except Quebec), this Agreement is an example of co-operation between governments on health and social issues to better meet the needs of Canadians. Among other things, the Agreement commits participating governments to be more accountable to citizens for the results of their social programs and activities. For further information on how the federal government is working to improve accountability under SUFA, see the SUFA Accountability Web site at
  http://www.tbs-sct.gc.ca/rma/account/sufa-ecus_e.asp.
   
• The Voluntary Sector Initiative (VSI): Our quality of life, our economic strength, and the vitality of our democratic institutions depend on the vibrancy of three interdependent sectors: the public, the private, and the voluntary. An accord has been developed as part of the VSI. Its purpose is to strengthen the ability of both the Government of Canada and the voluntary sector to better serve Canadians. The accord moves the two sectors toward greater mutual understanding and provides a framework within which the relationship can develop and evolve.
   
• Infrastructure Canada: The Government of Canada has launched a new program to renew and enhance Canada's physical infrastructure. The program will mobilize provincial, territorial, municipal, and private sector partners to address 21st century infrastructure challenges in rural and urban municipalities across Canada. Infrastructure Canada's first priority is green municipal infrastructure - projects that improve the quality of our environment and contribute to our national goals of clean air and water. Priority projects target water and wastewater systems, water management, solid waste management, and recycling. Other program priorities include local transportation; roads and bridges; affordable housing; telecommunications; and tourist, cultural, and recreational facilities.
   
• The National Homelessness Initiative (NHI): The NHI helps to ensure community access to programs, services, and support for reducing and alleviating homelessness in urban and rural regions across all provinces and territories. The initiative works through partnerships with community organizations, the private sector, and all levels of government to help people who are homeless in Canada. The NHI recognizes that no single level of government or sector of Canadian society can solve the problem of homelessness alone.

Further Information

This report cannot tell the whole story of Canada's performance. For more information on quality of life in Canada, see the suggested list of "Additional Resources" in Appendix I. The electronic version of this report includes many links to additional information on the societal indicators discussed in this report, as well as to information on the plans and performance of federal departments and agencies.

Give us Your Feedback

The government recognizes the need to continually improve its reporting to Canadians. With last year's report we sought your views. By listening to your comments and by consulting various stakeholders, we identified a number of areas of improvement for this year's version. For instance, we have improved the access that the reader has to more detailed levels of performance information in the electronic version.

We want to know what you think about the contents of this report. Please tell us what you like best about this publication and what you think needs to be changed or improved. Your feedback will help the government determine the form of its reporting to Canadians and to Parliament on management and performance issues.

We welcome your comments by mail, telephone, fax, or e-mail.

Treasury Board of Canada Secretariat
Results Based Management
300 Laurier Avenue West
9^th Floor, West Tower
Ottawa ON K1A 0R5

Telephone: (613) 957-7183
Facsimile: (613) 957-7044

E-mail: RMA-MRR@tbs-sct.gc.ca

Performance Highlights

This report provides information on the quality of life of Canadians by using nineteen societal indicators grouped under four themes: economic opportunities and innovation in Canada, the health of Canadians, the Canadian environment, and the strength and safety of Canadian communities. The following chart provides a brief summary of Canada's performance in these areas over the last 5 to 10 years (depending on the relevance and availability of data).

In general, the results indicate that we are doing well, as a nation, when it comes to our health; improvements are particularly noticeable in the area of life expectancy and infant mortality. Also, Canada's economy has shown strong performance, especially in the area of employment. However, some of Canada's environmental indicators continue to be a cause for concern. So too, the results indicate that not all members of our society are reaping the benefits of our strong economic performance. With respect to our communities, while some progress has been made in neighbourhood safety, other indicators point to a less involved civic society.

Economic Opportunities and Innovation in Canada

The Issue
 

With one of the world's strongest economies, Canadians continue to enjoy one of the highest standards of living, while maintaining the principle of sharing the benefits of this prosperity among all citizens. Although a global economic slowdown affected all major economies in 2001, its impact was not felt as severely in Canada. Moreover, the Canadian economy recovered with more strength and speed than that of other countries, including the United States.

This strong economic performance can be linked to our solid fundamentals. In the 2001-02 fiscal year, the federal government recorded a budgetary surplus of $8.9 billion, its fifth consecutive surplus. Consequently, the federal net debt was reduced by the same amount, resulting in a net debt-to-GDP ratio of about 49% in 2001-02, compared with a high of almost 71% in 1995-96.

Inflation and interest rates continue to be low and stable, and our economic growth prospects for the next couple of years look positive according to official forecasts from the International Monetary Fund and the Organisation for Economic Co-operation and Development (OECD).

In an increasingly competitive and technology-driven world economy, however, Canada faces many challenges in order to maintain a high standard of living. The greatest potential for improving living standards lies in improving productivity growth and competitiveness, two areas where Canada has lagged behind the United States for many years. A more productive and competitive economy benefits all aspects of the economy and society. Specifically, it encourages investment dollars to come into Canada, helps create opportunities for skilled Canadians and valued Canadian companies to remain in Canada, and facilitates global expansion of Canadian businesses and exports.

In 2002, the federal government launched Canada's Innovation Strategy (www.innovationstrategy.gc.ca), which is designed to improve the productivity and competitiveness of the economy by improving the level of innovation. A modern, competitive economy is one that has a high level of innovation, which results in new products for international markets and in more efficient ways to produce goods and services.

Presented in two papers - Achieving Excellence: Investing in People, Knowledge and Opportunity and Knowledge Matters: Skills and Learning for Canadians - the strategy provides a roadmap for improving innovation and outlines clear priorities and targets. Achieving Excellence focusses on economic growth by encouraging increased knowledge through investments in Research and Development and by ensuring that the appropriate business and regulatory policies are in place to encourage and recognize investment and innovation excellence.

In Knowledge Matters, the government outlines a plan to ensure that Canada will have a highly skilled and adaptable workforce by ensuring that all Canadians are able to realize their education and employment potential. This includes ensuring access to post-secondary institutions based on ability, recognizing foreign credentials, attracting skilled immigrants, as well as increasing literacy skills of Canadians.

After the release of the innovation strategy, the government launched a national engagement process, which aims to identify priorities for action for all partners in order to achieve national innovation goals.

The role of the federal government is to work with other governments, businesses, institutions, and Canadians to help ensure that Canada is a magnet for investment, skilled knowledge workers, cutting-edge research, and science and innovation. The government also ensures that economic growth is sustainable and leads to opportunities for all Canadians.

Making progress in these areas will be challenging, but the solid fundamentals of the economy, our modern infrastructure, and our well-educated workforce combine to form a durable foundation for success. Evidence from the last two years suggests that some progress has already been made.

This chapter provides a snapshot of the state of economic opportunities and innovation in Canada as determined by the six following indicators:

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• Real gross domestic product (GDP) per capita indicates the real level of resources available to make Canadians better off. It is the inflation-adjusted value of all products and services produced in a country relative to the size of the population.
   
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• Real disposable income per capita focusses more on an individual's take-home income. It is personal-sector income after taxes and transfers, adjusted for inflation. It excludes income used to produce government goods and services, such as education and health, which is captured in real GDP per capita.
   
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• Innovation is the process through which economic and social value is extracted from new knowledge. It has a direct bearing on quality of life by improving the productivity and competitiveness of an economy. Through innovation, goods and services are produced more efficiently and new products are brought to market.
   
• The employment rate is the percentage of working-age people who have jobs. A higher employment rate has the direct effect of raising household income and is thus an important element in raising the average standard of living.
   
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• Literacy is crucial to the development of basic skills and lifelong learning. Many countries promote it with the aim of improving their economic health and the human condition of their citizens. Literacy is especially important in today's highly competitive global economy and countries are quickly moving to develop and nurture their own human capital, recognizing it as central to their economic success.
   
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• Educational attainment measures the human capital of the nation, and it indicates the quality and skills level of the workforce. A well-educated and well-trained labour force is critical to the social and economic well-being of the country, enabling it to take advantage of economic opportunities and generate innovative ideas. Education plays a role in raising the skills and competencies of the population, thereby improving the capacity of people to live, work, and learn well.

What We Know

Real gross domestic product (GDP) per capita: Commonly used as an indicator of economic well-being, real GDP per capita is the inflation-adjusted value of all products and services produced in a country relative to the size of the population. It is, as well, a measure of income generated by production within the country on a per person basis. 

The average standard of living of Canadians has increased substantially over the past several years. Real GDP per capita growth has averaged 3 per cent per year since 1997, a substantial improvement over the early 1990s. This strong growth has allowed Canada to maintain one of the highest standards of living among the G-7 countries, second only to that of the United States in 2001

Canada's position relative to the United States on this measure has been slipping over the past two decades. The gap between the living standards of the two countries has widened considerably since 1980, primarily reflecting slower productivity and employment rate growth in Canada. Improving our productivity requires increasing the average amount that each worker produces. This requires investing more in innovation; adopting new advanced technologies, including new machinery; and continuing to build a highly skilled workforce. Indeed, these are key components of the government's 2002 innovation strategy.

Real disposable income per capita: Similar to real GDP per capita, real disposable income per capita is dependent on a variety of factors, such as productivity, the employment rate, changes in taxes, and transfers to individuals.

Canadians continued to realize gains in their real disposable income in 2001. After declining in the first half of the 1990s, real personal disposable income growth has picked up since 1997, reflecting strong employment growth and cuts in personal income taxes. Real disposable income per capita grew at an average rate of 2.1 per cent per year between 1997 and 2001.

Despite the strong growth in average incomes, there is still progress to be made. The Canadian income tax system and federal direct income transfers, such as the Canada Child Tax Benefit, work to limit the gap in income between the highest and lowest earning groups in Canada. These policies of income redistribution have been effective in keeping this income gap almost unchanged over the last 20 years. Even so, there is a growing gap in wealth (net worth) among Canadians, and certain segments of our society disproportionately experience economic hardships.

Innovation is a fundamental building block of productivity, competitiveness, and income growth. In today's world, innovation through new knowledge has become the main source of competitive advantage in all sectors of economic activity. The knowledge base of an economy can be defined as "the capacity and capability to create and innovate new ideas, thoughts, processes and products, and to translate these into economic value and wealth." (Competitiveness Index 2002: Benchmarking the Globe's High Performing Regions, Huggins and Izushi) This means coming up with new ideas about how to do things better or faster or creating a product or service that has not been developed or thought of previously.

Various studies have shown that Canada is a weak performer in innovation. OECD studies, for instance, suggest that an "innovation gap" separates Canada from leading OECD countries. Similarly, the World Economic Forum rates Canada's current innovation capacity as only tenth in the world, far behind the United States with its first place ranking. The corresponding chart shows that in a number of indicators of innovation performance, Canada is considerably behind the US and other G-7 countries.

The World Economic Forum indicates, however, that Canada is well positioned to make progress in innovation, with an innovation growth potential ranking of first in the world, a reflection, in part, of our high post-secondary enrolment. Some progress has begun to be visible. In 2000, Canada moved up from sixth to fifth place among G-7 nations with respect to total research and development spending as a percentage of GDP (R&D intensity), and this expenditure increased again in 2001 to 1.92% of GDP.

Also, in another indicator of innovation, connectedness, which indicates the ability to use information and communication technologies to interact and transact with one another, Canada is one of the better performing countries, ranking second behind the United States in the Conference Board of Canada Connectedness Index. This can be seen in the high level of high-speed Internet usage in Canada, 6.2 connections per 100 inhabitants, the highest of all G-7 countries.

To build on this high level of connectedness, the Government of Canada has committed to being the government that is the most connected to its citizens. Under the Government On-line Initiative, Canadians will be able to access all government information and services on-line by 2005. We are already making commendable progress. In 2002, for the second year in a row, Canada was ranked first in the world for electronic access to government programs and services. (eGovernment Leadership - Realizing the Vision, Accenture, 2002)

Employment: A high employment rate is a key element in achieving a high average standard of living. The rate is sensitive to a variety of factors, such as general economic condition and age distribution of the population.

The global economic slowdown that persisted through much of 2001 affected the pace of employment growth in Canada. In 2001, annual average employment grew by only 1.1 per cent, after strong average growth of 2.6 per cent from 1997 to 2000. By the end of 2001, however, economic recovery was well underway, and the Canadian labour market has created a record number of new jobs thus far in 2002: 427,000 in the first nine months. The renewed strength in the labour market helped put the employment rate back on the upward trend that began around 1997.

There has been a significant reduction in Canada's unemployment rate over the 1990s as well. On an annual basis, Canada's unemployment rate dropped from 11.4% in 1993 to 7.2% in 2001. With the Canadian labour market performing better than that of the United States in 2001 and so far in 2002, the gap between the unemployment rates in the two countries has narrowed from almost five percentage points in late 1996 to 2.1 percentage points by September 2002.

Despite the progress made in the last few years, a number of Canadians continue to experience employment difficulties. For example, the Atlantic provinces and Quebec continue to have substantially higher unemployment rates than the Canadian average. The rates among Aboriginals and recent immigrants are also much higher.

Literacy: Literacy skills matter to a nation because they enable its workforce to compete in a changing world, opening the way for economic growth and enhanced quality of life. A basic level of literacy is now required to get and keep most jobs and to adjust to changing economic opportunities. This is more than simply being able to read and write; it refers to an individual's ability to understand and use different types of information.

The International Adult Literacy Survey (IALS) is an important tool that has helped to shape the way we think of literacy today. The IALS has five levels of proficiency ranging from the lowest (Level 1) to the highest (Level 5), and tests for three types of literacy - prose, document, and quantitative. In general, Level 3 indicates the minimum desirable threshold in many countries, corresponding roughly to successful high school completion and college entry.

The low-level literacy of some Canadians presents a serious problem in the new knowledge-based economy where continual skills upgrades are necessary. One of the federal government's objectives outlined in the innovation strategy is to work with partners to substantially lower the percentage of Canadians with poor literacy skills over the next decade.

Encouragingly, 15-year-old Canadians did very well in a recent Programme for International Student Assessment (PISA). Among the 32 countries, Canada placed second in reading, fifth in science, and sixth in mathematics. Overall, Canada's performance exceeded the OECD averages.

Educational Attainment affects the likelihood of an individual finding employment, the type of employment, and the security of that employment. Education contributes to the wealth of Canadian citizens, families and society as a whole.

In recent decades, the demand for skills has risen in OECD countries. In Canada, between 1990 and 2001, 2.8 million jobs were created for graduates with post-secondary education in contrast to 0.3 million for high school graduates and a loss of 1.1 million jobs for people with less than high school education.

The Canadian workforce is a relatively skilled one. Since 1976, the percentage of Canadians graduating from post-secondary institutions has been increasing, making Canada the leader among G-7 nations in the percentage of the working age population with post-secondary education. Consistent with this, the percentage of youths dropping out of high school has been decreasing.

As of 1999, the national high school dropout rate for 20-year-olds was 12%, a substantial decline from 18% in 1991. (HRDC and Statistics Canada, 2002)

Provincially, the high school dropout rate was lowest in Saskatchewan and highest in Prince Edward Island.

There are, however, areas to be improved. Canada lags behind most OECD countries in the number of Ph.D. graduates, which is critical to our R&D capability. Also, educational attainment among Aboriginals, although improving, remains lower than that of other Canadians.

Performance Information

Many federal organizations are working to improve economic opportunities and innovation in Canada. To do so, these organizations plan, monitor, and report on their programs, policies, and initiatives in accordance with broad "strategic outcomes."

Strategic outcomes are the enduring benefits to Canadians that departments and agencies attempt to achieve. These outcomes flow from the mandates of federal organizations and contribute to broad, government-wide priorities. In most cases, strategic outcomes require the combined resources and sustained effort of several partners over a long period of time.

Federal organizations report on their strategic outcomes in two sets of documents tabled annually in Parliament. In their Reports on Plans and Priorities (RPPs), departments and agencies provide information on objectives, initiatives, and planned results - including links to related resource requirements. In their Departmental Performance Reports (DPRs), departments and agencies describe the accomplishments achieved against the performance expectations set out in the RPPs.

The Canada Economic Development Agency for Quebec Regions is one example of a federal organization that is contributing to the government-wide attempt to improve economic opportunities and innovation in Canada.

Following is a list of some of the other departments and agencies that have strategic outcomes related to economic opportunities and innovation in Canada. Further information on these strategic outcomes is available via hyperlinks in the electronic version of this report. Clicking on the departments and agencies listed below will lead the reader to the Government of Canada's "Strategic Outcomes Database."(http://www.tbs-sct.gc.ca/rma/krc/so-rs_e.asp) This Database provides information (and links for further references) on planned activities and expenditures, results evidence, relevant audits and evaluations, and program background for the government's more than 200 strategic outcomes.

In addition to the departments listed below, there are certain federal organizations that provide support to all departments and agencies such as the Treasury Board of Canada Secretariat, the Public Service Commission of Canada, Statistics Canada, and Public Works and Government Services Canada. Information on the performance and plans of these organizations is also available at the Strategic Outcomes Database Web site.

In the table below, departments have been clustered into several "horizontal areas;" these are areas in which several departments and agencies are working toward a common goal.

This tentative clustering of departmental efforts will facilitate horizontal or whole-of-government thinking. It helps to identify common leverage points by which different federal organizations can plan strategies and monitor success in their efforts to improve economic opportunities and innovation in Canada.

The Health of Canadians

The Issue
 

The health of Canada's society, as well as Canada's success in the 21^st century, depends on the health and well-being of individuals and communities. Not surprisingly, Canadians attach great importance to their own health and that of their families, friends, and communities.

Many factors influence health. These go beyond the individual and interact in complex ways. They include social support networks, education, employment and working conditions, social environment, physical environment, personal health practices, healthy child development, biology and genetic endowment, health services, gender, and culture. (Towards a Common Understanding: Clarifying the Core Concepts of Population Health, discussion paper, Health Canada, 1996)

The evidence shows that we need to think of health in a broad sense as something influenced by individual and collective action. That means we all have a part to play: in the personal choices and environmental, nutritional and physical activity decisions we make, in the care we give those who are sick, and in shaping government policy. At the same time, many determinants of health are influenced not only by individuals but by the social, economic, and physical environments as well as the action of such players as governments, businesses, and voluntary organizations.

The health care system is one important part of the larger agenda for a healthier Canada. While Canada's health care system is often described as an interlocking set of 10 provincial and 3 territorial plans, the federal government is the fifth largest provider of health services to Canadians and is responsible for the following:

• providing health care services to such groups as veterans, military personnel,² inmates of federal penitentiaries, and members of the Royal Canadian Mounted Police. Health Canada provides health services to First Nations populations on reserves, communities in the territories, and to the Inuit through community-based nursing stations, health centres, and other facilities in isolated and remote areas;
   
• health protection in general (including disease surveillance, monitoring the effects of changes in the environment on health, regulating pharmaceuticals and medical devices);
   
• food safety and nutritional quality standards of the Canadian food supply;
   
• occupational health and safety services, and the health of travelling public;
   
• developing strategies to promote health, prevent disease, and educate the public about the health implications of the choices they make;
   
• health information and research, through supporting organizations, such as the Canadian Institute of Health Research, the Canadian Institute for Health Information, the Social Sciences and Humanities Research Council of Canada, Statistics Canada, and other research programs, including those conducted at Health Canada;
   
• contributing significant financial support to provincial health care systems; and
   
• providing a stewardship role with regard to the principles contained in the Canada Health Act.

This chapter of Canada's Performance 2002 offers general information on the overall health of Canadians, not on health care system performance. Still, many Canadians are concerned about the health care system, including such matters as unmet health care needs and the availability of emergency services or health care personnel. Furthermore, Canada's population is aging. This has implications for the health care system, and we need to do a good job of supporting and anticipating the needs of older people.

The Government of Canada is committed to working with the provinces and territories to renew and strengthen our health care system. For instance, as part of an agreement with the provincial and territorial governments at the September 2000 First Ministers' meeting, the federal government committed $21.2 billion over five years to the Health Action Plan. The investment will enable all governments to move forward in building a modern and sustainable health system for Canadians.

Citizens have a right to know what their investment in health is yielding. The September 2000 First Ministers' meeting outlined clear commitments to increase accountability and reporting, and in November 2001, a set of proposed indicators was endorsed by the federal, provincial, and territorial Deputy Ministers.

In September 2002, governments across Canada, for the first time, reported to citizens about health status, health outcomes and quality of service using a set of common indicators - a concrete step toward increased accountability to Canadians. As public reporting continues on how the health system is meeting the needs of Canadians, governments will be able to use the information to renew and strengthen medicare. The Government of Canada's report entitled Healthy Canadians - A Federal Report on Comparable Health Indicators is available at: http://www.hc-sc.gc.ca/hcs-sss/pubs/care-soins/2002-fed-comp-indicat/index_e.html.

Canadians continue to take pride in our public system of health care, while at the same time having concerns for its future. In February 2002, the Commission on the Future of Health Care, headed by former Saskatchewan Premier Roy Romanow, released an interim report. The primary focus of the Commission is the long-term sustainability of the health care system. The interim report served as a framework for the Commission's public and stakeholder consultation process. The Commission's final report will be presented to the Prime Minister in November 2002.

A good way to assess the health of Canadians is by focussing on a few key indicators. This chapter provides a snapshot of the overall health of Canadians based on four indicators.

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• Life expectancy has long been regarded as a basic and reliable indicator of the overall health of a population, although it has sometimes been criticized for emphasizing longevity over quality of life. Even so, life expectancy allows for reliable comparisons over time and across jurisdictions.
   
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• Self-rated health status measures physical and mental health as experienced by citizens themselves. It is an assessment of wellness, not simply the absence of disease. It can also be a good predictor of the existence of more objectively measured problems.
   
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• Infant mortality is often used as a basic indicator of social and economic development, allowing for reliable comparisons over time and across jurisdictions.
   
• Unlike the other three indicators, physical activity influences health as opposed to being a measure of it. Lack of physical activity has long been recognized as a risk factor for coronary heart disease. Physical activity provides many health benefits, including weight control; reduced risk of diabetes, cancer, and osteoporosis; stress reduction; and more. Consequently, the level of leisure time physical activity undertaken by individuals is highly relevant to the overall health of Canadians.

These four indicators alone cannot give a truly complete picture of the health of Canadians, but they do highlight the important elements of that picture. For example, with the exception of physical activity, the indicators do not reveal the specifics of how various economic, social, and environmental forces are interacting to shape our health (many of these factors are dealt with in other chapters of this report). Taken together, however, they give us a good idea of how healthy we are.

What We Know

 Life expectancy is the number of years a person would be expected to live, starting from birth. A widely used indicator of the health of a population, life expectancy at birth addresses longevity rather than quality of life.

Life expectancy at birth in Canada is among the highest in the world. Overall life expectancy in Canada has steadily increased: from 59 years in the early 1920s to nearly 79 by 1999. (Health Canada Performance Report 2000-01)

Since 1961, Canada's life expectancy has consistently ranked among the top 10 of the 30 OECD countries. In 1999, Canadian male life expectancy at birth was in fifth place, behind Iceland, Japan, Sweden, and Switzerland. Canadian female life expectancy at birth was seventh. (OECD Health Data, 2002)

Life expectancy at birth reached record heights for both sexes in 1999, 76.3 years for men and 81.7 years for women. In 1996 the life expectancy for women was almost six years higher than that for men. By 1999, the gap in life expectancy between the sexes closed to 5.4 years. (The Daily, May 7, 2002, Statistics Canada)

Disability-free life expectancy introduces the concept of quality of life. This indicator measures the number of years a person could expect to live free of any activity limitation. (Health Indicators, December 2001) Estimates of disability-free life expectancy from 1995 to 1997 indicate that women could expect to spend just over 12 years, or 15% of their lives, with a disability, compared with about 10 years, or 13%, for men. Thus, the longer total life expectancy for women does not mean that they have an equivalent advantage in disability-free years. (How Healthy are Canadians? Statistics Canada, 2001) High obesity rates, high smoking rates, and high rates of depression are associated with shorter disability-free life expectancies. (The Health of Canada's Communities, Statistics Canada, 2002)

Self-rated health status measures physical and mental health as citizens themselves perceive it.

In 2000-01, 62.1% of Canadians aged 12 and over rated their own health as being either very good or excellent, slightly lower than 65.7% in 1998-99. The percentage of Canadians who rated their health as fair or poor increased from 9.0 per cent in 1998-99 to 11.6 per cent in 2000-01. (Health Indicators, May 2002)

Overall in 2000-01, men were more likely than women to rate their health as being very good or excellent (63% versus 59.9%). Among age groups, about 73% of those aged 12 to 14 rated their health as very good or excellent. The proportion reporting either very good or excellent health generally decreased with age, down to a low of some 36% for those aged 65 and over. (Health Indicators, May 2002)

Internationally, Canadians continue to be among the world's people most likely to rate their health as good. According to OECD data, Canada and the United States have the highest percentage of people assessing their own health to be "good" or better. There is, however, no standardized way of measuring perceived health status, and caution is advised when comparing data from different nations. (OECD Health at a Glance: 2001)

The infant mortality rate has decreased by 1 death per 1,000 live births since 1993. After five years of declines, the infant mortality rate remained unchanged in 1999 at 5.3 deaths per 1,000 live births. The mortality rate of infant boys in 1999 was 5.7 deaths, slightly higher than 4.8 for infant girls. (The Daily, May 7, 2002, Statistics Canada)

As specialized medical care for expectant mothers and, subsequently, their newborns has improved and access to it has expanded, the survival rate has risen for extremely premature babies. This has led to an increase in the number of high-risk newborns registered as births rather than non-births. The result has been a slowdown in the rate of infant mortality reduction.

Canada's progress in combatting infant mortality is good from a North American perspective, but it is less impressive when compared with that of Europe or Japan. In 1999, Canada ranked 17^th according to OECD Health Data 2002. Iceland ranked number 1 on the list with 2.4 infant deaths per 1,000, while Japan and Sweden followed in second place each with 3.4 infant deaths per 1,000.

Physical activity: There is scientific evidence that physical activity plays a key role in improving health and in preventing disease, disability, and premature death. People who are inactive face a greater risk of Type 2 diabetes, premature death, heart disease, obesity, high blood pressure, osteoporosis, stroke, depression, and colon cancer. Studies indicate that physical activity can reduce the risk of Type 2 diabetes by over 50% (Health Canada, "Physical Activity," 2002) and that the odds of having heart disease are significantly higher for those who are sedentary (5.0%) or those who engage in only light physical activity (3.7%) than for those who engage in moderate or vigorous physical activity (1.0% and 1.3% respectively). (Body Mass Index and Health, Statistics Canada, 1999)

According to the 2000-01 Canadian Community Health Survey, 42.6% of Canadians aged 12 and over were at least moderately physically active during their leisure time, up 3.2% from the 1994-95 survey. The prevalence of physical activity increased in almost all age groups, with the largest gain occurring among 20- to 34-year-olds. (Canadian Community Health Survey: A First Look, Statistics Canada, 2002) The survey also indicates that women have almost caught up with men in levels of leisure time physical activity. In 1994-95, about 36% of women aged 20 to 64 were physically active, compared with 39% of men. By 2000-01, a larger increase in physical activity for women had closed the gap to 41% of women and 42% of men in this age range. (Canadian Community Health Survey: A First Look, Statistics Canada, 2002)

Performance Information

Many federal organizations are working to improve the health of Canadians. To do so, these organizations plan, monitor, and report on their programs, policies and initiatives in accordance with broad "strategic outcomes."

Strategic outcomes are the enduring benefits to Canadians that departments and agencies attempt to achieve. These outcomes flow from the mandates of federal organizations and contribute to broad, government-wide priorities. In most cases, strategic outcomes require the combined resources and sustained effort of several partners over a long period of time.

Federal organizations report on their strategic outcomes in two sets of documents tabled annually in Parliament. In their Reports on Plans and Priorities (RPPs), departments and agencies provide information on objectives, initiatives, and planned results - including links to related resource requirements. In their Departmental Performance Reports (DPRs), departments and agencies describe the accomplishments achieved against the performance expectations set out in the RPPs.

Health Canada is one example of a federal organization that is contributing to the government-wide attempt to improve the health of Canadians.

Following is a list of some of the other departments and agencies that have strategic outcomes related to the health of Canadians. Further information on these strategic outcomes is available via hyperlinks in the electronic version of this report. Clicking on the departments and agencies listed below will lead the reader to the Government of Canada's "Strategic Outcomes Database" (http://www.tbs-sct.gc.ca/rma/krc/so-rs_e.asp). This database provides information (and links for further references) on planned activities and expenditures, results evidence, relevant audits and evaluations, and program background for the government's more than 200 strategic outcomes.

In addition to the departments listed below, there are certain federal organizations that provide support to all departments and agencies such as the Treasury Board of Canada Secretariat, the Public Service Commission of Canada, Statistics Canada, and Public Works and Government Services Canada. Information on the performance and plans of these organizations is also available at the Strategic Outcomes Database Web site.

In the table below, departments have been clustered into several "horizontal areas;" these are areas in which several departments and agencies are working toward a common goal.

This tentative clustering of departmental efforts will facilitate horizontal or whole-of-government thinking. It will help to identify common leverage points by which different federal organizations can plan strategies and monitor success in their efforts to improve the Health of Canadians.