Section I:
Overview

Minister's Message

Addressing the fundamental issues of health is one of my key areas of focus as Minister of Health. Perhaps more than ever, effective strategies for health promotion, health protection, and disease and injury prevention are instrumental in helping Canadians maintain and improve their health.

The Government of Canada is putting renewed emphasis on public health through the newly created Public Health Agency of Canada and the identification of a new health leadership position - the Chief Public Health Officer. This reflects our understanding of, and commitment to, an integrated and comprehensive view of health. The Agency will be exploring innovative ways to promote and protect the health of Canadians and to engage citizens and stakeholders in shaping the Agency's policies, programs and priorities.

The creation of the Agency also marks the beginning of a new approach in federal leadership and partnership with the provinces and territories on public health. Governments, public health experts and citizens all agree that Canada needs to enhance its commitment to public health and strengthen its capacity to respond to increasingly complex public health issues.

Further, Canadians have said that we need to improve our ability to anticipate, track and respond to new and emerging infectious diseases as well as the growing number of risk factors common to many chronic diseases.

The Agency is committed to action on these two fronts.

This first Report on Plans and Priorities of the Public Health Agency of Canada outlines the Government of Canada's public health priorities. These priorities are intended to best reflect how the Government of Canada can continue to contribute to Canada's public health requirements, and how Canadians can benefit from a world-class public health system.

The Agency will look to capitalize on investments in public health networks of experts. It will demonstrate leadership, innovation and a commitment to action in public health in Canada. The Agency will also foster domestic and international partnerships with stakeholders to further enhance our government's commitment to ensure healthy Canadians and communities in a healthier world.

I am confident that the Agency will provide a meaningful contribution to Canada's public health system and the overall health of Canadians.

Ujjal Dosanjh
Minister of Health

Message from the Minister of State (Public Health)

The arrival of Severe Acute Respiratory Syndrome (SARS) in Canada was an event that none of us wants to see repeated. But it was also a wake-up call for Canadians, an early warning that, in today's world of rapid, transcontinental travel and mobile populations, delivering health care without a robust and active public health component is fighting only half the battle.

The creation in September 2004 of the Public Health Agency of Canada and the appointment of the country's first Chief Public Health Officer are two concrete signs that not only has the government learned the lesson of SARS but it has also launched a new era in health, one that stresses prevention alongside treatment.

As a physician, I know that one of the critical components of healthy public policy is a strong and effective public health system. That is why I am pleased that the Agency is up and running. It is also personally gratifying for me to be working with a Minister and dedicated Agency staff for whom the health of Canadians is of the utmost concern.

This Report on Plans and Priorities again confirms the Government of Canada's commitment to public health as a tool for improving the health outcomes of Canadians.

In the first six months of operation, the Agency has made great strides in carrying out its overarching goal of leading federal efforts to prevent and control disease and injuries and to promote health. As we move forward, the Agency will undertake action to increase our preparedness against unexpected infectious outbreaks, whether naturally occurring or human-initiated, build our public health knowledge base through science, and advance policies and choices to prevent chronic diseases and injuries.

The Agency is fully aware that it cannot achieve its broader goals without the engagement and collaboration of the provinces, the territories and non-governmental partners or without bringing the Canadian people into the process. During 2005-2006, the Public Health Agency of Canada will continue to enlist Canadians as partners in establishing public health goals and targets, a process that will be carried into the future so as to build accountability, transparency, evidence-based decision-making and public dialogue into the DNA of the new Agency.

I fully expect that the renewed emphasis on public health through the leadership of the Agency and the Chief Public Health Officer will provide major long-term benefits in the lives and health of Canadians.

Dr. Carolyn Bennett MD
Minister of State (Public Health)

Message from the Chief Public Health Officer

The new Public Health Agency of Canada was established last September to lead federal efforts to promote and advance public health nationally and internationally.

Although the Agency is young, I am proud of the success that has already been achieved. We articulated our vision, mission and mandate, and are making the structural and organizational changes that will serve the Agency in the future. We managed the repercussions of a flu vaccine shortage in the U.S. We launched the second phase of the Global Public Health Intelligence Network and opened a second Emergency Operations Centre in Winnipeg. We played a significant role in Canada's humanitarian response to the tsunami disaster in Southeast Asia, including airlifting significant quantities of materials, equipment and medicines to the stricken region. We are taking a leadership role in establishing a pan-Canadian Public Health Network. And, we created a national antiviral stockpile, in partnership with the provinces and territories, enhancing Canada's status as a world leader in preparedness against an influenza pandemic.

Looking ahead, the Agency will work with the provinces and territories to engage experts and Canadians in the development of public health goals and targets through broad citizen participation and consultation. We will make health promotion and the prevention and control of both chronic diseases and communicable diseases key objectives of the Agency, alongside emergency preparedness.

To accomplish this, the Agency will build on the experiences of the past and, in collaboration with the provinces, the territories and partners, develop the science-based strategies and policies needed to give Canadians the best possible protection against unexpected communicable diseases and preventable chronic illness. In 2005-2006, the Agency will ensure that it has a modern and efficient infrastructure in place to enable it to deliver on its mandate.

This Report on Plans and Priorities focusses on three critical priorities for the Agency over the next three years: developing and leading Canada's long-term strategic public health approach; establishing and implementing integrated and disease-specific strategies; and developing and enhancing the capacity of the new Agency to meet its important mandate at both its Winnipeg and Ottawa pillars, as well as in Canada's regions.

I, and the many dedicated staff in the Agency, look forward to making real progress toward our vision of healthy Canadians and communities in a healthier world.

Dr. David Butler-Jones MD
Chief Public Health Officer

Summary Information

Our Vision - Healthy Canadians and communities in a healthier world

Departmental Plans and Priorities

Setting the Context

Public health consists of a range of efforts to keep people healthy and out of hospital. It includes activities such as immunization, promoting healthy eating and physical activity, and use of infection control guidelines in hospitals. It also includes emergency preparedness and response, detection, surveillance, laboratory testing and regulation to support these and other activities. By helping keep Canadians healthy, public health can relieve some of the pressure on the health care system.

Public health targets the entire population by working to identify threats and risks to the health of Canadians at large, as opposed to health care, which focusses on the individual. While they are both part of the continuum of health, the emphasis in public health is the preventable, whereas health care may be thought of as largely curative.

In today's rapidly changing environment, Canadians are at risk from a number of different public health threats and we - governments, public health professionals and experts, non-health sectors of society, individual citizens in Canada and abroad - all have a role to play in facing these challenges.

Globally, population growth has exerted increased pressure on the natural environment, increasing the likelihood of a disease crossing from animals to humans (zoonosis), while urbanization, population mobility and an increasingly global food supply have created environments in which infections can incubate and be transferred. By responding to these risks, public health helps not only to prevent and control the spread of infectious disease but also to protect the health of Canadians from potential bioterrorism threats and major communicable disease outbreaks.

Trends in the risk factors that lead to chronic diseases show that such factors are also increasing, as are disparities in the health status of some specific population groups. Changing demographics in Canada's population, threats in the physical environment, a more sedentary lifestyle and an increase in the number of Canadians with unhealthy eating habits leave us more vulnerable to chronic disease.

In addition to these worrisome trends and risks to public health, the National Advisory Committee on SARS and Public Health (the Naylor Committee, http://www.hc-sc.gc.ca/english/protection/warnings/sars/learning.html ), the Government of Ontario's Campbell Commission ( http://www.sarscommission.ca/report/Interim_Report.pdf ) and Walker Panel ( http://www.health.gov.on.ca/english/public/pub/ministry_reports/walker_panel_2003/introduction.pdf ), and the Standing Senate Committee on Social Affairs, Science and Technology ( http://www.parl.gc.ca/37/2/parlbus/commbus/senate/com-e/soci-e/rep-e/repfinnov03-e.htm ) highlighted the importance of establishing a federal focal point for public health. They identified the following challenges:

• lack of clarity in leadership, legislative authorities, roles and responsibilities;
• uneven capacity and coordination within and between jurisdictions, particularly related to surveillance;
• shortage of public health human resources, including surge capacity;
• gaps in laboratory capacity and emergency response;
• uncoordinated research efforts; and
• unclear risk communications.

The experts agreed that action is needed.

On September 24, 2004, the Government of Canada announced the creation of the Public Health Agency of Canada ( http://www.phac-aspc.gc.ca/new_e.html ). Our vision is healthy Canadians and communities in a healthier world. It is our mission to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health. The Agency has a significant regional service presence that enables key programs and services to be delivered directly to target populations in their communities in collaboration with the provinces and territories, federal and international partners, and stakeholders. The Agency will work with other federal departments to advance public health.

Building on Success

As part of the broader Government of Canada health portfolio, the Public Health Agency of Canada's corporate priorities for 2005-2006 reflect newly emerged public health needs as well as those identified by ongoing activities transferred from Health Canada ( http://www.hc-sc.gc.ca/english/index.html ) to form the core of the Agency:

1. Develop and lead (in collaboration with partners) Canada's long-term strategic public health initiatives;
2. Develop, enhance and implement integrated and disease-specific strategies; and
3. Develop and enhance the capacity of the new Agency to meet its mandate.

Priority One: Develop and lead Canada's long-term strategic public health initiatives

In collaboration with the provinces, the territories, stakeholders, and health portfolio and other partners, the Agency will be:

• Identifying goals for improving the health status of Canadians;
• Developing the Pan-Canadian Public Health Strategy;
• Establishing the Pan-Canadian Public Health Network;
• Facilitating the establishment of, and providing ongoing support to, the National Collaborating Centres for Public Health; and
• Continuing to enhance public health emergency preparedness and response.

Priority Two: Develop, enhance and implement integrated and disease-specific strategies

In 2005-2006, the Agency will continue to develop integrated and disease-specific strategies for chronic disease and healthy living as well as to examine opportunities to integrate strategies for infectious diseases.

An integrated approach means that we identify common risk factors (e.g., physical inactivity) and focus our efforts on preventing and thereafter mitigating the effects of these factors. Disease-specific strategies are those that work to identify, prevent and mitigate risk factors that relate to particular diseases.

As the federal government's lead for health promotion and healthy living, the Agency will continue, in collaboration with Health Canada and other government departments, to encourage Canadians to engage in healthy activities to improve and maintain their quality of life and reduce their chances of getting sick. We will continue to strive to assist Canadians in their efforts to maintain their health for as long as possible by leading healthy lifestyles, and to promote healthy public policies at all levels of government.

Priority Three: Develop and enhance the capacity of the new Agency to meet its mandate

In 2005-2006, the Agency will prepare its enabling legislation, which will set out the mandate of the Agency, the role and responsibilities of the Chief Public Health Officer, and the powers of the Minister.

In our first full year of operation, we will finalize our new organizational structure, focussing our efforts on achieving results, embracing program and policy innovation, showing leadership, partnering effectively and demonstrating commitment. Our approach to human resources and organizational development will ensure that our structure and program activities support our priorities and achieve the results that Canadians expect of their federal public health agency.

We will forge relationships with the provinces and territories, our colleagues, partners, stakeholders and other parties to demonstrate leadership, develop and deploy the necessary levers and tools, and coordinate strategies and responses. The Agency's leadership role in public health carries with it a responsibility to make evidence-based decisions in the most effective strategic areas. By strengthening public health linkages, we will be better able to contribute to Canada's international obligations, share public health expertise with global partners, and enhance the credibility of our public health system.

The Agency will actively promote excellence in science and continue to enhance and support evidence-based decision-making. We are strengthening our support of science and research activities, starting with a Public Health Framework for Science and Research, which will reflect the overall health portfolio approach.

The Agency has an ambitious agenda, and we will ensure that our staff has the necessary knowledge and skills required to develop and deliver the right public health advice and tools to Canadians. The Agency will adopt policies and practices to retain and recruit a workforce that is well suited to fulfilling its mandate and objectives.

An important part of the Agency's forward planning will be the development of its Winnipeg pillar. The Agency will also build upon its regional presence in health promotion and explore the establishment of stronger regional public health capacities that will allow it to connect to public health partners across the country. In order to ensure a high degree of collaboration and accountability, we are adopting a formal citizen engagement strategy that will better involve Canadians in decision making.

In all aspects of our efforts and activities, we expect to be held accountable: by Parliament, by partners and by stakeholders - indeed by all Canadians.

Section II:
Analysis of the Agency's Strategic Outcome and Program Activity

Departmental Strategic Outcome: Healthier Population by Promoting Health and Preventing Disease and Injury

Program Activity: Population and Public Health

In the transition from being part of Health Canada to being established as a separate Government of Canada department in September 2004, the Public Health Agency of Canada is currently organized under one Strategic Outcome and one Program Activity.

In collaboration with the provinces, the territories, and health portfolio and other partners, the Agency leads federal efforts and mobilizes pan-Canadian actions in promoting and protecting national and international public health. These actions include anticipating, preparing for, responding to and recovering from threats to public health; and monitoring, investigating and reporting on diseases, injuries, other preventable health risks and their determinants. The Agency is also responsible for monitoring the general state of public health in Canada, in light of international health trends, to support effective actions in prevention and health promotion, and for building and sustaining a public health network with stakeholders. The Agency uses the best available evidence and tools to support national and international public health stakeholders as they work to enhance the health of their communities, and to provide public health information, surveillance, advice and leadership.

The Agency's programming falls into four broad categories:

• Emergency Preparedness and Response
• Health Promotion and Chronic Disease Prevention and Control
• Infectious Disease Prevention and Control
• Public Health Tools and Practice

In the rest of the section, some of the key programs and services related to these categories are described as well as their contribution to the Agency delivering on its mandate.

Emergency Preparedness and Response
( http://www.phac-aspc.gc.ca/cepr-cmiu/index.html )

Preparing for and responding to emergencies is a key component of public health.

The Agency works closely with partners in Health Canada, other federal departments, and the provinces and territories to identify, develop and implement preparedness planning priorities and to develop public health emergency response plans.

Guidance for the Agency's emergency preparedness and response work comes from the Federal/ Provincial/Territorial Network on Emergency Preparedness and Response, based on the Ministers of Health's Special Task Force on Emergency Preparedness and Response that was created after the September 11, 2001 terrorist attacks in the U.S.

The Agency's activities in emergency preparedness and response fit within the recently completed National Framework for Health Emergency Management, which provides a consistent, inter- operational approach to health emergencies that respects jurisdictional specificities and priorities. It is consistent with, and supportive of, the Government of Canada's overall National Readiness and Response System.

While the programs and services described below are some of the more prominent emergency preparedness and response activities undertaken by the Agency's lead in this area, the Centre for Emergency Preparedness and Response, other elements - notably the Centre for Infectious Disease Prevention and Control and the National Microbiology Laboratory - also receive a portion of these financial resources and contribute in a substantive manner to how the Agency fulfils its mandate. As well, the Agency collaborates with other federal government departments and agencies within the health portfolio and Public Safety and Emergency Preparedness Canada, which have the lead in other aspects of emergency preparedness and response.

The Agency's work on emergency preparedness and response capacities supports our priority to develop and lead Canada's long-term strategic public health initiatives.

Emergency Preparedness Capacity
( http://www.phac-aspc.gc.ca/ep-mu/index.html )

Emergency operational preparedness, planning and exercising ( http://www.phac-aspc.gc.ca/cepr-cmiu/oeppt-dmupf/index.html ) contribute directly to the Public Health Agency of Canada's emergency preparedness capacity. By focussing the Agency's efforts on these elements, we expect to see increased confidence among Canadians that the Government of Canada is better prepared to respond to national health-related emergencies. Of primary benefit to Canadians is the recognition that Canada is always working to improve its state of readiness to respond to all emergencies involving hazards that threaten the health of the public. The Agency prepares, plans and trains effectively with its partners to maintain an appropriate level of emergency preparedness for all Canadians.

The Agency is responsible for activating the National Emergency Response Assistance Plan, pursuant to the Transportation of Dangerous Goods Act , to respond to inadvertent spills of dangerous pathogens during their transportation. It equips and coordinates 15 national response teams and regularly conducts national training sessions for federal, provincial and territorial participants to maintain response readiness. This approach will continue for the next three years.

In the past year, the Agency has created Emergency Preparedness and Response Regional Coordinators across the country to interface with provincial and territorial government emergency preparedness authorities to refine region-specific planning and act as liaisons with other federal government departments through the federal government regional councils. This will also continue over the next three years.

The Agency will continue to provide accurate and timely national and global public health events information to Canadian and World Health Organization (WHO) officials through the Global Public Health Intelligence Network ( http://www.phac-aspc.gc.ca/media/nr-rp/2004/2004_gphin-rmispbk_e.html ), and will help to coordinate public health security by providing essential resources to front-line health workers across the country.

The Agency provides training for emergency preparedness to ensure that available professionals are skilled in course design, adult education and course delivery and helps partners to develop their own emergency training capacity. As well, the Agency plans, coordinates and implements various exercise designs to test existing operational plans to enhance preparedness before the lessons learned are incorporated.

The Agency will continue to support its nationwide quarantine service, strengthened after the SARS outbreak, in order to ensure that a robust capacity exists to act under the Quarantine Act to deal with the possible importation of dangerous infectious diseases.

By enhancing emergency preparedness capacity through planning, operational preparedness, training and exercising, the Agency expects that Canadians will benefit from a more efficient and effective response that reduces the effects of health-related emergencies.

Emergency Response Capacity

The Agency mobilizes federal resources and coordinates pan-Canadian capabilities for emergency health and social services within Canada and internationally. The Agency has targeted the enhancement of this capacity as a key program over the next few fiscal years. Canadians should expect to see improved response in the event of a public health-related emergency.

The Agency inspects and certifies high risk (Level 3 and 4) bio-containment facilities, and issues permits for the importation of human pathogens (Human Pathogens Importation Regulations). It ensures that Agency and Health Canada laboratories respect the requirements for handling radioactive materials and for transportation of dangerous goods and hazardous materials, including toxic waste and chemical and toxic substances. Through the development and application of national biosafety policies and guidelines, the Agency provides national expertise on biosafety-related issues.

The Agency, the RCMP and DND are members of the National Capital Region's Joint Chemical, Biological Radiological and Nuclear (CBRN - http://www.phac-aspc.gc.ca/cepr-cmiu/ophs-bssp/links_index_e.html ) Response Team, which provides expertise, specialized equipment, facilities and scientific support in response to threatened, perceived or actual incidents involving biological weapons or agents. The Agency provides on-site mobile detection and response capability, as it did at the 2002 G8 Summit in Kananaskis, and it will continue to enhance its laboratory response operations in both its first response laboratory and its mobile response isolator.

The Agency also contributes directly to Canada's role and participation in the Global Health Security Initiative, the international partnership to improve global public health security against the threat of chemical, biological, radiological and nuclear terrorism, and pandemic influenza.

The Agency has a direct operational linkage with Public Safety and Emergency Preparedness Canada to integrate the health sector's emergency preparedness and response capacity with the overall Government of Canada's National Emergency Management Framework. This important liaison function will be enhanced to include operational linkages with the Agency's Emergency Operations Centres.

The Agency's National Emergency Stockpile System (NESS - http://www.phac-aspc.gc.ca/ep-mu/ness_e.html ) maintains supplies in a robust and versatile system that includes items ranging from small backpack trauma kits to complete 200-bed emergency hospitals. At eight federal warehouses located strategically across the country and approximately 1,600 storage sites under federal/provincial/territorial care, the NESS will continue to have a 24/7 response capability as well as the ability to deliver these supplies anywhere in Canada within 24 hours of receiving a request for assistance.

The Agency further participates directly in health emergencies by helping to coordinate provincial and territorial emergency health and social services through the Council of Health Emergency Management Directors and the Council of Emergency Social Services Directors ( http://www.phac-aspc.gc.ca/emergency-urgence/index_e.html ).

In December 2001, the National Office of Health Emergency Response Teams (NOHERT - http://www.phac-aspc.gc.ca/cepr-cmiu/ophs-bssp/nohert_e.html ) was established to develop Health Emergency Response Teams (HERT) that will assist the provinces and territories to create surge capacity in emergency situations.

In 2005-2006, two HERTs will be staffed, trained and supplied. In each of 2006-2007 and 2007-2008, an additional team will be staffed, trained and supplied in addition to maintaining ongoing activities. In the event of a public health emergency, the federal government would activate HERTs at the request of a province or territory, or in response to an event falling under federal jurisdiction.

Canadians will benefit directly from better coordination and planning, and a more rapid and targeted response to public health emergencies.

Health Promotion and Chronic Disease Prevention and Control

Individual health is much more than the just the absence of disease. The Agency recognizes that it is important to keep Canadians as healthy as possible for as long as possible. The Agency supports health promotion as a foundation for healthy living and the prevention and control of chronic and infectious diseases.

Broad systemic issues, including the environments in which we live and work, our culture, and other interrelated factors, affect individual health status. This is reflected in the population health/determinants of health approach the Agency uses for all its health promotion and disease prevention activities. It is the basis of several investments in community programming ¹ related to children as well as in critical partnerships with other federal government departments such as Health Canada and Canadian Heritage.

The Agency works closely with health portfolio departments and agencies, provincial/territorial governments and voluntary organizations to identify emerging areas of concern, develop pan-Canadian action plans for health promotion, disseminate information to the public and to health professionals, integrate multiple and diverse interests and perspectives, and furnish a critical link between citizens and government policy- and decision-makers.

The Agency's key programs and services in this area range from those that promote health and healthy living for all Canadians, and prevent chronic disease and injury among the many Canadians who are at elevated risk for these problems, to those that detect diseases early and manage them well so that people can live disability-free and productive lives.

To develop policy, research and programs related to specific identifiable target populations - such as children and adolescents, and seniors - the Agency maintains partnerships, collaborative relationships and networks with important domestic and international organizations, other federal departments and provincial/ territorial governments specific to target populations.

The Agency is also engaged in integrated and disease- specific prevention and control activities, in particular, programs and services related to cardiovascular disease, cancer, diabetes and respiratory diseases - the leading causes of death and disability in Canada.

The Agency collaborates with the provinces and territories on the development of both pan-Canadian and international integrated and disease-specific strategies, policies and programs for chronic disease prevention and control, and oversees their implementation in collaboration with other governments and stakeholders. This includes the development of chronic disease surveillance programs, the dissemination of evidence in support of these programs and the development of prevention, screening, and management strategies for chronic diseases.

¹ See Table 6 in Section III for more details on the Agency's community investments.

The Agency works through the World Health Organization Collaborating Centre for Non-communicable Disease (NCD) Policy. As the only WHO-designated Collaborating Centre on NCD policy in the Americas or Europe, it directly contributes to the strengthening of the global response to chronic diseases and the support of the development and implementation of chronic disease prevention policy in Canada, the Americas and Europe. In addition, the Agency is working closely with the U.S. Centers for Disease Control and Prevention on issues relating to cardiovascular and other chronic diseases.

The Agency's commitment to health promotion and chronic disease prevention and control is concrete recognition that an integrated view of health is the best way to support its priorities of developing and leading Canada's long-term strategic public health initiatives, and developing, enhancing and implementing its integrated and disease-specific strategies.

Integrated Healthy Living Strategy
http://www.hc-sc.gc.ca/english/lifestyles/healthyliving/index.html

The Agency actively promotes healthy living through the Pan-Canadian Healthy Living Strategy, a federal/provincial/territorial collaborative effort for health promotion and disease prevention based on the population health approach. Endorsed by Ministers of Health in September 2002, the Strategy's initial goals are to reduce health disparities and improve health outcomes, emphasizing physical activity, healthy eating and their relation to healthy weight.

By establishing links between existing strategies within the health portfolio and other federal government departments and agencies (such as on tobacco use and control, alcohol, diabetes and chronic disease prevention) and new collaborative efforts on emerging issues (such as school health), this integrated approach will mobilize action and engage partners across jurisdictions, the health system and other sectors. It will also work through the determinants of health; target common risk factors for multiple diseases and injury, and consolidate promotion and prevention efforts where people work, live, learn and play. These goals will be achieved through the work of the Intersectoral Healthy Living Network, and the development of a research and surveillance agenda and a communications/health information strategy.

The Agency actively encourages and supports collaborative action with health portfolio partners and other government departments and non-governmental agencies to promote the importance of being physically active in daily life. It increases awareness and understanding of the benefits of physical activity. It supports healthy eating, and the relation of both physical activity and healthy eating to healthy weight. The healthy living initiative also supports programs, such as active transportation ( http://www.phac-aspc.gc.ca/pau-uap/fitness/active_trans2.html ), which contribute to sustainable development.

The Agency aims to reduce the burden of mental health disorders, and to maintain and improve the mental health and well-being of Canadians by addressing mental health issues from a population health perspective. Mental health promotion activities include the development, synthesis, dissemination and application of knowledge; and the development, implementation and evaluation of policies, programs and activities designed to promote mental health and address the needs of people with mental health disorders. In the coming year, the Agency will emphasize this important area of public health.

The Agency operates the National Clearinghouse on Family Violence ( http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/webli-international_e.html ), Canada's resource centre for information on violence within relationships of kinship, intimacy, dependency or trust. With its twelve federal Family Violence Initiative partner departments (including Indian and Northern Affairs Canada and Status of Women Canada), the Agency will continue to collect, develop and disseminate information on family violence across the country and abroad.

The Agency expects that, through its activities, there will be increased awareness of issues related to physical activity, mental health and family violence; increased community capacity to develop and implement policy and programs relating to physical activity, mental health and family violence; strengthened capacity at an intersectoral level to deal with these issues; and increased collaboration and partnerships in these three areas.

Integrated Strategies for Chronic Disease

Chronic diseases should no longer be considered in isolation. Strategies to enhance the health of Canadians are strengthened when they work together with the efforts of health partners. The Agency advocates a comprehensive and integrated approach across a range of public health activities including the promotion of health, and the prevention, management and control of chronic health problems and injury.

The Agency collaborates with the provinces, the territories, stakeholders and international partners on chronic disease prevention and control through surveillance and risk assessment, and in the development of integrated policies and programs. The Agency anticipates that this will result in enhanced chronic disease science capacity and surveillance to inform public health policies and legislation.

Actions that target more than one risk factor or more than one chronic disease enhance the overall awareness of chronic diseases, their risk factors and complications among health professionals and the general public, and improve public health practices for the prevention and early detection of chronic diseases.

Evidence has also shown that comprehensive, integrated and sustained efforts to prevent and reduce a few key risk factors common to the major chronic diseases are successful in preventing and reducing the impact of chronic disease. In 2005-2006, the Agency will continue to develop integrated strategies for chronic disease and healthy living in collaboration with health portfolio partners, the provinces and territories, and with other Canadian and international public health partners. This comprehensive approach will address the common risk factors for major chronic diseases, such as the relation between unhealthy eating and physical inactivity and unhealthy weight.

Chronic Disease-Specific Strategies

In addition to its integrated approach to common chronic disease risk factors, the Agency continues to target certain specific chronic diseases with significant social, medical and economic burdens for Canadians.

Cardiovascular diseases ( http://www.phac-aspc.gc.ca/ccdpc-cpcmc/cvd-mcv/index_e.html ) are the number one killers in Canada. Diseases such as stroke and heart disease put the greatest burden on the health care system. The Agency has the lead federal role for cardiovascular disease, including overall coordination of the prevention and control of cardiovascular diseases, as well as surveillance and data interpretation. The Agency will continue to work closely and collaboratively with a number of key partners and several actions will be advanced, building on the Canadian Heart Health Initiative, the Cardiovascular Action Plan, and targeted hypertension strategies.

The goals of the Canadian Strategy for Cancer Control, jointly developed by governments and stakeholders, are to prevent cancer, cure cancer and increase survival rates and quality of life for those with cancer by converting knowledge gained through research, surveillance and outcome evaluation into strategies and actions. Consultations have produced a plan for collaborative action in priority areas, and implementation has begun in several strategic areas: research; supportive, psychosocial and palliative care; primary prevention; standards; guidelines; human resource planning; and surveillance.

Through the Canadian Breast Cancer Initiative (CBCI - http://www.phac-aspc.gc.ca/ccdpc-cpcmc/bc-cds/index_e.html ), the Agency continues to work collaboratively with cancer control stakeholders to address breast cancer issues ranging from prevention to palliative care. One of the most successful outcomes of this collaboration has been the development of systematic breast cancer screening. In 2005-2006, the Agency will continue to evaluate the results of its contributions to the CBCI to reduce breast cancer incidence and mortality and improve the quality of life of those affected by breast cancer.

Diabetes is a growing epidemic in Canada. About two million Canadians, or more than 5% of Canadian adults, have this chronic disease, and 60,000 new cases are diagnosed each year. Recognizing the social and economic burden of this disease, the Government of Canada launched a five-year Canadian Diabetes Strategy ( http://www.phac-aspc.gc.ca/ccdpc-cpcmc/diabetes-diabete/english/strategy/index.html ), which was extended with funding of $30 million in the 2004 Budget. Actions undertaken include enhanced diabetes surveillance and support for community organizations to increase awareness of the disease and its prevention. In 2005-2006, the Agency will focus its efforts on the control and management of the disease for populations at risk and for those living with diabetes.

Through our efforts, we expect that health professionals and the public will have a higher awareness of chronic diseases, their risk factors and complications, and how best to respond to control and mitigate their effects.