Annual Report - The Chief Public Health Officer of Canada’s 2021 Report on the State of Public Health in Canada: ‘ A Vision to Transform Canada’s Public Health System’

A backgrounder with details on the Chief Public Health Officer of Canada's 2021 Annual Report, A Vision to Transform Canada’s Public Health System.

December 13, 2021

“Public health is the outbreak that did not happen, the traumatic injury that did not occur, and the overdose that was avoided. Public health protects our healthcare system by reducing the need for medical treatments, and helping people to stay healthy and well. As the pandemic has clearly demonstrated, when we fail to prioritize public health, people get sick, the healthcare system can become overwhelmed, and the economy suffers.”

Dr. Theresa Tam
Canada’s Chief Public Health Officer

This morning the annual report of the Chief Public Health Officer of Canada, Dr. Theresa Tam, was tabled in the House of Commons and the Senate. The 2021 Report is entitled: ‘A Vision to Transform Canada’s Public Health System.’

The report is an appeal to strengthen our public health system in Canada in order to be better equipped against present and future health threats. The 2021 report builds on Dr. Tam’s 2020 report (French) From Risk to Resilience: An Equity Approach to COVID-19, which examined the unequal impacts of COVID-19 on the health of people in Canada and the need for a strong public health system centred on equity.

Drawing on lessons learned from the pandemic and dialogues with public health leaders from across the country, this year’s report identifies strategic opportunities and proposes a series of concrete actions to better prepare for the next health emergency and to help all people in Canada achieve better health. These actions are outlined in the Way Forward section of the report.

The report is intended to stimulate a national dialogue and catalyze collective action on public health renewal. The report was informed by many sources, including discussions with public health leaders from across the country and at all levels of government, academics, First Nations, Inuit and Métis leaders, and community experts. A summary of these consultations can be found in a companion report, ‘What We Heard: A Renewed and Strengthened Public Health System in Canada.’

About the Report

Section 1 | COVID-19 in Canada and the World: Provides an overview of key COVID-19 epidemiological events from August 2020 to August 2021 and the broader health impacts of the pandemic. This includes how COVID-19 increased the obstacles many people face to achieving good health, such as financial instability, food insecurity, family and gender-based violence, low education, stigma and discrimination. This section also provides early lessons learned from managing the pandemic.

Section 2 | Opportunities for Public Health Transformation in Canada: Describes the unique role and impact of public health systems on the health of people living in Canada. It examines the foundational building blocks of the Canadian public health system, and identifies opportunities to transform the public health system to be stronger and more resilient.

Section 3 | A Vision to Transform Public Health in Canada: Outlines the tools and foundational elements of a transformed, world-class public health system in Canada and offers  a Way Forward, with a series of concrete actions that can be taken to strengthen the public health system in light of our pandemic experience. 

The Way Forward

The report identifies four priority action areas for public health renewal:

1. Foster excellence in the public health workforce: Canada’s public health workforce is stretched thin, after repeatedly rising to the challenges of the pandemic. The report calls for:
   • The recruitment and retention of a more diverse and inclusive workforce that reflects the communities it is serving.  
   • Developing expertise and modernizing skills.
   • Building surge capacity through partnerships to rapidly expand the workforce during crises. 
2. Improve our tools: Our public health system and workforce need the right tools for effective decision-making – including better data, evidence, and insights, including:
   • Filling long-standing gaps in our pan-Canadian data and surveillance systems, by ensuring the right data is available at the right time to detect emerging health issues, identify populations at risk, and improve predictive capabilities.
   • Respecting First Nations, Inuit and Métis data ownership principles and broaden the public health knowledge base to incorporate holistic Indigenous ways of knowing and learning.
   • Strengthening collaborations to rapidly synthesize emerging evidence on public health threats and translate into effective policy and practice.
   • Building a stronger Canadian research agenda to understand which interventions and models work best to improve population health and reduce health inequities.
3. Modernize public health governance and collaboration structures: The pandemic has demonstrated the need for effective collaboration across governments, sectors and communities to address public health crises and the social factors that influence health. The report calls for:
   • A strengthened role and mandate for public health within federal, provincial and territorial governments to ensure health systems continue to focus on preventing disease and promoting good health for all.
   • More systematic collaboration across sectors to address the broader circumstances that support good health, such as education, housing, and food security, with collective action based on measurable indicators.
   • A regular annual report card for Canadians on progress in reaching common public health objectives and reducing health inequities.
   • Enabling community and local voices, in particular those from at-risk or marginalized communities, to shape public health priorities and co-design solutions.
4. Ensure stable and consistent funding: Public health faces “boom and bust” funding cycles that leave us ill-prepared for new emergencies. The report calls for:
   • Stepped-up funding to future-proof our public health system and ensure it can deliver on its core functions, of health promotion, prevention and emergency preparedness.
   • Investments to ensure First Nations, Inuit and Métis communities are supported to develop their own public health priorities and plans.
   • Providing federal funding to support common public health priorities and objectives, accompanied by the development of indicators to report on outcomes across federal/provincial/territorial jurisdictions.

Key facts

• In the 20th century alone, it has been estimated that advances in public health increased the average life expectancy at birth in Canada by 25 years.^{Footnote 1}
• While difficult to measure precisely, it is estimated that public health accounted for just 6% of total health spending in Canada in 2019.^{Footnote 2}
• According to some studies, every dollar spent on public health interventions generates on average more than 14 dollars in savings down the road, by preventing illness and reducing direct and indirect health costs.^{Footnote 3}

Background and previous reports:

Canada’s Chief Public Health Officer (CPHO) is mandated under the Public Health Agency of Canada Act to provide the Minister of Health with an independent report on the state of public health in Canada each year. The Actmandates that the Minister of Health table the report in parliament and that it be accessible to Canadians.

The CPHO reports are intended to create awareness and stimulate action, ultimately seeking to improve and protect the health of Canadians.

Previous annual reports from Canada’s Chief Public Health Officers are available online and have called attention to public health issues such as stigma in the health system, substance use among youth, and the elimination of tuberculosis.

Quotes:

“The pandemic has highlighted the strengths of our system, but it has also exposed longstanding cracks in the foundation. The public health system lacks the necessary resources and tools to carry out its critical work, and is the subject of “boom and bust” funding cycles that leave us ill-prepared in the face of new threats. We must do better for the future.“

Dr. Theresa Tam
Canada’s Chief Public Health Officer

“Joining forces across governments, communities and sectors, we can define the public health system that we all need and expect, in pursuit of the healthy and thriving society that we all want. It is in working together that we can make sure that we get it right”

Dr. Theresa Tam
Canada’s Chief Public Health Officer

Annex

What is public health?

Public health’s role has become more visible during the COVID-19 pandemic but it largely works behind the scenes and it has a broad mandate. Public health is the part of the health system that works on prevention and health promotion. Its purpose is to help all people in Canada achieve optimal health and well-being.

While the healthcare system treats individual patients, public health’s patient is the population.

Aims of our public health system in Canada:

1. improve population health;
2. protect against health emergencies and mitigate the impacts; and
3. achieve equitable outcomes – or ensure that all people in Canada have an equal opportunity to be healthy and well.

To achieve these aims, our public health system performs these essential functions:

1. health promotion; promoting the conditions that drive good health, such as education, safe housing, and food security, through partnerships with communities and other sectors
2. health surveillance;  using data to monitor population health and disease trends
3. health protection; protecting the population from infectious disease, environmental threats, and unsafe water, air, and food
4. population health assessment; understanding the health of communities and specific populations to inform policies and interventions
5. disease and injury prevention; promoting safe and healthy lifestyles and reducing the risk of infectious disease outbreaks
6. emergency preparedness and response; planning for natural or human-made disasters to minimize serious illness and death, and responding to emergencies while minimizing societal disruption

What is Canada’s public health system?

Public health is a shared responsibility in Canada across multiple jurisdictions and actors.

• Public health is organized differently within Canada’s provincial/territorial jurisdictions. This includes approximately 80 regional health authorities and municipal or local public health units across the country, depending on the provincial/territorial structure.
• At the federal level, the Public Health Agency of Canada (PHAC) provides a national leadership role for public health within the broader Health Portfolio that includes Health Canada, the Canadian Food Inspection Agency, the Canadian Institutes of Health Research, and the Patented Medicine Prices Review Board.
• Public health services for First Nations, Inuit, and Métis communities are mainly divided between federal and provincial/territorial governments.