Introduction: The Chief Public Health Officer's Report on the State of Public Health in Canada 2014

Introduction

Public health and Canada's Chief Public Health Officer

Public health is defined as the organized efforts of society to keep people healthy and prevent injury, illness and premature death and disability, improving health and well-being and reducing inequalities in health.

It focuses on preventing disease and optimizing the health of the population rather than the illnesses of individuals. It is the combination of programs, services and policies that protect and promote health. The Public Health Agency of Canada (the Agency) and the position of Canada's Chief Public Health Officer (CPHO) were established in 2004 to help protect and improve the health and safety of all Canadians. In 2006, the Public Health Agency of Canada Act (the Act) confirmed the Agency as a legal entity and further clarified the roles of the CPHO and the Agency.^{Footnote 1} Through the Act, the CPHO has a legislated responsibility to report annually to the public via the Minister of Health and Parliament on the state of public health in Canada.

The CPHO's reports are intended to highlight specific public health issues that the CPHO has determined warrant further discussion and action in Canada. As much as this report is a mechanism to increase awareness, it is also meant to inspire action to build upon existing health programs and initiatives and develop new solutions to promote, improve and maintain optimal health and well-being for all Canadians.

What this report is about

This report, rather than looking only at health status, particular disease outcomes or public health initiatives affecting Canadians today, considers how those issues may be affected by broader factors that are likely to influence public health in the future.

Public health in Canada has certainly come a long way from its early 18^th century activities of quarantine measures to reduce the spread of disease.^{Footnote 2} Key innovations and milestones such as improvements in hygiene and sanitation late in the 19^th century and the introduction of immunization programs early in the 20^th century have had significant impacts on the increased life expectancy and improved health of Canadians over the last nearly 200 years.^{Footnote 2} More recently, events such as the outbreaks of severe acute respiratory syndrome (SARS) and H1N1 and the re-emergence of infectious diseases such as measles have shone a light on the important role public health plays in fostering the best possible health and well-being of Canadians. We have certainly learned from these events and will be able to apply our knowledge to help shape the direction public health will take in the future. However, there are also many unknowns that will also drive public health in the future.

Public health issues can emerge quickly and unexpectedly, and those working in public health must remain flexible and responsive to address any future challenges. Public health involves influencing the factors, inside and outside the health system, that impact health. These include income and social status, social support networks, education and literacy, employment and working conditions, social environments, physical environments, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, gender and culture. These determinants of health affect all Canadians throughout their lifecourse. When considering how public health will address these determinants in the future, we need to provide the context within which public health will be operating. Although it is impossible to know exactly what that context will be, we do know that public health will need to take into account, among other things, who is being helped, where those people are living and what tools they have at their disposal to carry out their efforts.

What this report covers

The who, where and what of public health in the future will encompass many things. While all three identified areas are quite broad, each has been tailored to address some of the key public health concerns.

Who: Changing demographics, aging and health

We know that the age distribution of the Canadian population is shifting. Canadians born during the baby boom will soon represent the largest proportion of the population as seniors. Public health needs to be concerned about this large and growing senior population as well as future generations of seniors. This section broadly explores Canada's changing demographics and their influence on select health and social issues. This section looks at both the current burden of disease for seniors that will continue to impact individuals and societies in the future, as well as troubling health trends among younger age groups that will have short and long term public health implications.

Where: Public health in a changing climate

People have become increasingly cognizant of their environment and its impact on their health. The environment section of the report addresses the where of public health in the future by exploring our changing climate and its impact on health. This section briefly outlines the ways in which the climate is changing, followed by an examination of how those changes in climate and weather are influencing the health of Canadians. It also identifies broad areas of action that can be taken to prepare for and adapt to change in order to mitigate climate-related health risks.

What: Digital technology as a tool for public health

Public health uses numerous tools to deliver its programs and services. In looking at what tools may be used in the future, technology seems an obvious choice for examining the what of public health in the future. Technology is constantly and rapidly changing, permeating all aspects of Canadians' lives. It has also become a tool for public health to inform and assist Canadians on health and safety issues. This section contains examples of how digital technology in particular can be and is being used to address several key functions of public health, including health promotion and protection, education and awareness, and surveillance. It also notes some of the challenges and opportunities around the use of certain technologies and how this may shape public health practices in the future.