Structural Profile of Public Health in Canada

The structure of public health in Canada is complex. The federal government, the ten provinces and three territories are all structured differently. This resource, designed in the form of a table, shows the reader how public health is organized within each of these jurisdictions.

The most recent update of the Structural Profile of Public Health in Canada occurred in 2018.

To consult the Structural Profile overview, click here.

Alberta

This text includes excerpts from government websites and official publications. Websites and publications from other relevant organizations were also consulted. These have been supplemented by information from key provincial or territorial stakeholders, whenever relevant (cited as personal communication within the text). Certain recent changes or updated responsibilities may not be reflected in this document as it is primarily based on information available online.

This document presents the public health organizations that exist at the federal, provincial or territorial and regional levels and describes their mission, their composition, and any significant reforms that have helped shape the current structure of the public health system. The latter is limited to changes in legislation, government reorganization or restructuring, and any other reforms that have occurred in the past ten years since the most recent update of the profile (2008-2018). When relevant, public health laws older than 2008 have been included.

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

ALBERTA

PROVINCIAL LEVEL

Alberta Health (Department of Health)

“Alberta Health is the ministry that sets policy, legislation and standards for the health system in Alberta. The ministry allocates health funding and administers provincial programs […] and provides expertise on communicable disease control” (Alberta Health, 2018a).

Within Alberta Health, in addition to the Office of the Chief Medical Officer of Health (CMOH), the Public Health and Compliance Division also “functions to protect the health of Albertans by providing strategic direction and leadership in the development of provincial policies, strategies, and standards in compliance monitoring, communicable diseases, immunization, environmental health, emergency preparedness, and health promotion… The division is [also] responsible for [the] development of policy options and action to support health promotion, including injury and disease prevention, and screening” (Alberta Health, 2018b).

Other divisions within Alberta Health with public health functions include the 1) Health Standards, Quality, and Performance Division which comprises the Analytics and Performance Reporting Branch responsible for epidemiology and surveillance and the 2) Health Services Delivery Division which comprises the Addiction and Mental Health Branch (Personal communication, October 12, 2018).

Ministry of Children’s Services

Ministry of Community and Social Services

Other provincial ministries with public health functions include the Ministry of Children’s Services which oversees early intervention services, including childcare and early childhood development, and the Ministry of Community and Social Services which manages programs, including community-based supports, the Fetal Alcohol Spectrum Disorder (FASD) program, and family violence prevention (Personal communication, October 12, 2018).

Alberta Health Services

Alberta Health Services (AHS) is responsible for the planning and delivery of health services in Alberta (Alberta Health Services, n.d.-a).

Alberta Health Services has a broad Population and Public Health portfolio which includes the following program areas: Surveillance and Health Status Assessment; Health Promotion, Disease and Injury Prevention; Health Protection (including both Environmental Public Health and Communicable Disease Control); and Emergency/Disaster Preparedness (Alberta Health Services, n.d.-b).

The Alberta Health Services Board, re-introduced and effective as of 2015, is responsible for the governance of AHS and is accountable to the Minister of Health (Alberta Health, 2018a).

See the following organizational chart of Alberta Health Services.

Alberta Health Services covers five zones:
1. North Zone (Zone 5),
2. Edmonton Zone (Zone 4),
3. Central Zone (Zone 3),
4. Calgary Zone (Zone 2),
5. South Zone (Zone 1) (Alberta Health Services, n.d.-c).

These zones are now grouped into two sections, Northern Alberta (which comprises the Edmonton Zone and the North Zone) and Central & Southern Alberta (which comprises the Central, Calgary and South Zones) (Alberta Health Services, 2018).

A zone map of Alberta Health Services can be consulted below.

REGIONAL LEVEL

In May 2008, Alberta Health Services replaced “Alberta’s nine regional health authority boards, the Alberta Mental Health Board, Alberta Cancer Board and Alberta Alcohol and Drug Abuse Commission (AADAC)” (Government of Alberta, 2008). These services moved from municipalities to Alberta Health Services effective April 1, 2009 (Alberta Health Services, n.d.-a).

Public health programs and services are offered through Alberta Health Services (Alberta Health Services, n.d.-b).

CHIEF MEDICAL OFFICER OF HEALTH

Dr. Karen Grimsrud is Alberta’s Chief Medical Officer of Health (Alberta Health, 2018c).

“The Office of the Chief Medical Officer of Health provides direction and guidelines on public health policy to Alberta Health Services, and gives information to the public about communicable diseases and public health programs” (Alberta Health, 2018a). In particular, it “provides public health expertise to support health surveillance, population health and disease control initiatives on issues of public health importance” (Alberta Health, 2018c). The Chief Medical Officer of Health is also co-chair of the Minister’s Opioid Emergency Response Commission (Government of Alberta, 2018).

“The Chief Medical Officer of Health is a member of the Alberta Health executive team and reports to the Deputy Minister of Health. In extraordinary situations, such as a public health emergency, to ensure the welfare of Albertans, the Chief Medical Officer of Health may report directly to the Minister of Health” (Alberta Health, 2018c).

REFORMS

2017 – Creation of Minister’s Opioid Emergency Response Commission

The Minister’s Opioid Emergency Response Commission is created under the Opioid Emergency Response Regulation in the Public Health Act.

The Commission will oversee and implement coordinated actions on the opioid crisis, focused on the following six strategic areas:

harm-reduction initiatives
treatment
prevention
enforcement and supply control
collaboration
surveillance and analytics (Government of Alberta, 2018).

2016 – Amendment to Public Health Act

The Public Health Amendment Act, an amendment to the Public Health Act of 2000, is passed. This Act aims to facilitate the identification of students with incomplete immunization records, as well as strengthen the delivery of immunization services (Government of Alberta, 2016).

2009 – Creation of Alberta Health Services

Alberta Health Services is established under the Regional Health Authorities Act as a result of a merger between 12 formerly separate health entities (Alberta Health, 2018d, p.179; Alberta Health Services, n.d.-a).

REFERENCES

Alberta Health. (2018a). About us. Alberta Health. Setting strategic direction. Consulted on October 15, 2018: http://www.health.alberta.ca/about-us.html

Alberta Health. (2018b). Organizational structure. Consulted on October 15, 2018: http://www.health.alberta.ca/about/org-chart.html

Alberta Health. (2018c). Chief Medical Officer of Health. Consulted on October 15, 2018: http://www.health.alberta.ca/about/chief-medical-officer.html

Alberta Health. (2018d). Annual Report 2017–18. Alberta: Government of Alberta. Retrieved from https://open.alberta.ca/dataset/4bb6bc99-ab59-47fd-a633-dfc27d7a049e/resource/94b95989-e03a-4acc-8bf9-f080f911abf0/download/health-annual-report-2017-2018.pdf

Alberta Health Services. (n.d.-a). About Alberta Health Services. Consulted on October 15, 2018: https://www.albertahealthservices.ca/about/about.aspx

Alberta Health Services. (n.d.-b). Population Health. Consulted on October 15, 2018: https://www.albertahealthservices.ca/topics/Page1196.aspx

Alberta Health Services. (n.d.-c). Alberta Health Services Zone Map. Consulted on October 15, 2018: https://www.albertahealthservices.ca/ahs-map-ahs-zones.pdf

Alberta Health Services. (2018). Main AHS Org Structure. Consulted on October 15, 2018: https://www.albertahealthservices.ca/assets/about/org/ahs-org-orgchart.pdf

Government of Alberta. (2008, May 15). One provincial board to govern Alberta’s health system. News release. Retrieved from: http://www.alberta.ca/acn/200805/23523ED9498C0-0827-451C-E98A0B8430DC1879.html

Government of Alberta. (2016, November 7). Improved childhood disease protection behind Bill 28. News release. Retrieved from: https://www.alberta.ca/release.cfm?xID=4377786926060-D054-359C-36295FC562EE5F9B

Government of Alberta. (2018). Minister’s Opioid Emergency Response Commission. Consulted on October 15, 2018: https://www.alberta.ca/opioid-emergency-response-commission.aspx#toc-0

British Columbia

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

BRITISH COLUMBIA

PROVINCIAL LEVEL

Ministry of Health

At the provincial level, the Ministry of Health “has overall responsibility for ensuring that quality, appropriate, cost-effective and timely health services are available for all British Columbians. It sets the overall direction for the system, provides a legislative and regulatory framework to allow it to function smoothly, and plans for the future supply and use of health professionals, technology and facilities. The ministry supports and funds the activities of all regional health authorities, including all public health programs and services in British Columbia” (B.C. – Ministry of Health, n.d.-a).

“The ministry’s Population and Public Health Division is the focal point for the provincially coordinated and regionally delivered public health system. The division focuses on improving the population’s overall health and well-being by promoting health; preventing disease, disability and injury; protecting the population from harm; and addressing inequities in health status in populations and sub-populations” (B.C. – Ministry of Health, n.d.-a).

Ministry of Mental Health and Addictions

The Ministry of Mental Health and Addictions was created in 2017 to improve mental health service delivery across the province and provide better strategic direction in addressing the opioid public health emergency (B.C. – Ministry of Mental Health & Addictions, n.d.).

This new ministry “leads the Province of British Columbia (B.C.) in efforts to improve the mental well-being and reduce substance use-related harms for all British Columbians. The Ministry has overall responsibility for the development of a coherent, accessible, and culturally safe mental health and addictions system that is effective for individuals and families across the lifespan throughout the province. The Ministry is also responsible for leading an immediate response to the province’s opioid overdose public health emergency. The Ministry aims to strengthen social supports and services that impact mental health and well-being (for example, housing, employment, income, education, and childcare)” (B.C. – Ministry of Mental Health and Addictions, 2018).

Ministry of Children and Family Development

The Ministry of Children and Family Development sets policy for services relating to maternal health, and early childhood development and learning (Personal communication, October 12, 2018).

Provincial Health Services Authority

Besides the Ministry of Health, Ministry of Mental Health and Addictions, and the Ministry of Children and Family Development, B.C.’s health governance structure consists of five regional health authorities, and two province-wide entities: the Provincial Health Services Authority (PHSA) and the First Nations Health Authority (FNHA).

The Provincial Health Services Authority’s primary role is “to ensure that BC residents have access to a coordinated provincial network of high-quality specialized health-care services” (BC – Provincial Health Services Authority, 2018). Additionally, the Provincial Health Services Authority is “responsible for specialized provincial health services, which are delivered across the province in collaboration with regional health authorities, such as cardiac, trauma, perinatal and stroke services” (B.C. – Provincial Health Services Authority, 2018).

“The Provincial Health Services Authority operates the following provincial agencies and services:

BC Cancer Agency
BC Centre for Disease Control
BC Children’s Hospital & Sunny Hill Health Centre for Children
BC Emergency Health Services
BC Mental Health and Addiction Services
BC Renal Agency
BC Transplant
BC Women’s Hospital & Health Centre
Cardiac Services BC
Perinatal Services BC” (B.C. – Ministry of Health, n.d.-b).

BC Centre for Disease Control

The BC Centre for Disease Control is an agency of the Provincial Health Services Authority.

“The BC Centre for Disease Control (BCCDC) provides provincial and national leadership in public health through surveillance, detection, prevention, consultation and provides both direct diagnostic and treatment services to people with diseases of public health significance” (BC Centre for Disease Control, 2018a). More specifically, the BCCDC provides analytical and policy support to government and health authorities, acts as the provincial reporting centre for reportable cases and categories of communicable diseases, and takes part in research and education activities (BC Centre for Disease Control, 2015, 2018b).

First Nations Health Authority

On October 1st 2013, as part of the British Columbia Tripartite Framework Agreement on First Nation Health Governance, Health Canada transferred its role in First Nations health programming in British Columbia to the newly created First Nations Health Authority (FNHA). The FNHA assumed responsibility for the funding, planning, management, and delivery of health programs, in partnership with First Nations communities in BC.

“Services are largely focused on health promotion and disease prevention and include:

Primary Health Care
Children, Youth and Maternal Health
Mental Health and Wellness
Communicable Disease Control
Environmental Health and Research
First Nations Health Benefits
eHealth and Telehealth
Health and Wellness Planning
Health Infrastructure and Human Resources” (First Nations Health Authority, 2018)

REGIONAL LEVEL

Regional Health Authority

B.C.’s provincial health governance structure consists of five regional health authorities:

Fraser Health Authority
Interior Health Authority
Northern Health Authority
Vancouver Coastal Health Authority
Island Health Authority

“The province’s health authorities are the organizations primarily responsible for health service delivery. Five regional health authorities deliver a full range of health services, including public health services, to meet the needs of the populations within their respective regions” (B.C. – Ministry of Health, n.d.-a).

A map of the regional health authorities can be viewed below.

PROVINCIAL HEALTH OFFICER

The Provincial Health Officer is Dr. Bonnie Henry (B.C. – Ministry of Health, n.d.-c).

“The Provincial Health Officer is the senior public health official for BC, and is responsible for monitoring the health of the population of BC and providing independent advice to the ministers and public officials on public health issues.

The responsibilities of the Provincial Health Officer are outlined in the Public Health Act. As the senior public health official for British Columbia, the [Provincial Health Officer]:

Provides independent advice to the Ministers and public officials on public health issues;
Monitors the health of the population of British Columbia and advises, in an independent manner, the ministers and public officials on public health issues and on the need for public health related legislation, policies and practices;
Recommends actions to improve health and wellness in BC;
Delivers reports that are in the public interest and annual reports on the health of the population and government’s progress in achieving population health targets;
Establishes standards of practice for, and conducts performance reviews of Medical Health Officers; and
Works with the BC Centre for Disease Control and Prevention, and BC’s Medical Health Officers to fulfill their legislated mandates on disease control and health protection” (B.C. – Ministry of Health, n.d.-d).

REFORMS

2017 – Creation of the Ministry of Mental Health and Addictions

The Ministry of Mental Health and Addictions is created to improve mental health service delivery across the province, as well as develop an immediate response to the opioid public health emergency (B.C. – Ministry of Mental Health & Addictions, n.d.).

2017 – Update of B.C.’s Guiding Framework for Public Health

An updated version of BC’s Guiding Framework for Public Health is released, with updated measures, baselines and targets (B.C. – Ministry of Health, n.d.-e).

2013 – Transfer of First Nations Health Services

The First Nations Health Authority assumes control of programs, services, and responsibilities formerly handled by Health Canada’s First Nations Inuit Health Branch – Pacific Region (B.C. – Ministry of Health, n.d.-f).

2013 – B.C.’s Guiding Framework for Public Health

A guiding document for the public health system is published. This Guiding Framework provides a long-term vision for the public health system, formalizes a collaborative process to identify future public health priorities, and unifies resources and strategies that are in place to support public health and address key challenges (B.C. – Ministry of Health, n.d.-e; 2013, p. 4).

2008 – Public Health Act

A new Public Health Act replaces the Health Act, the Venereal Diseases Act and the Public Toilet Act. Additionally, it works in parallel with two other pieces of public health legislation, the Drinking Water Protection Act and the Food Safety Act. The Act addresses current and emerging public health issues, clarifies the roles and responsibilities of public health officials, grants them stronger powers, and provides additional tools, such as the ability to require public health planning, and issue orders, as well as modern inspection powers, improved health monitoring abilities, and measures necessary to respond to emergencies (i.e. quarantine and isolation provisions) (B.C. – Ministry of Health, n.d.-g, 2008).

REFERENCES

BC Centre for Disease Control. (2015). What We Do. Retrieved from: http://www.bccdc.ca/resource-gallery/Documents/Communications/BCCDC_WhatWeDo.pdf

BC Centre for Disease Control. (2018a). What We Do. Consulted on October 15, 2018: http://www.bccdc.ca/about/who-we-are/what-we-do

BC Centre for Disease Control. (2018b). About. Consulted on October 15, 2018: http://www.bccdc.ca/about

B.C. – Ministry of Health. (n.d.-a). About Public Health. How is the Public Health System Organized in BC? Consulted on October 15, 2018: https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/about-public-health/for-the-public#organized

B.C. – Ministry of Health. (n.d.-b). Provincial Health Services Authority. Consulted on October 15, 2018: https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/health-authorities/provincial-health-services-authority

B.C. – Ministry of Health. (n.d.-c). Office of the Provincial Health Officer. Biographies. Consulted on October 15, 2018: https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/biographies

B.C. – Ministry of Health. (n.d.-d). Office of the Provincial Health Officer. Consulted on October 15, 2018: https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer

B.C. – Ministry of Health. (n.d.-e). B.C.’s Guiding Framework for Public Health. Consulted on October 15, 2018: https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/health-priorities/bc-s-guiding-framework-for-public-health

B.C. – Ministry of Health. (n.d.-f). First Nations Health Authority. Consulted on October 15, 2018: https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/health-authorities/first-nations-health-authority

B.C. – Ministry of Health. (n.d.-g). Public Health Act. Consulted on October 15, 2018: https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/legislation/public-health-act

B.C. – Ministry of Health. (2008, April 9). New B.C. legislation to support public health action. News release. Retrieved from: https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/legislation/public-health-act/public_health_act_news_release.pdf

B.C. – Ministry of Health. (2013). Promote, Protect, Prevent: Our Health Begins Here. BC’s Guiding Framework for Public Health. British Columbia: Government of British Columbia. Retrieved from: http://www.health.gov.bc.ca/library/publications/year/2017/BC-guiding-framework-for-public-health-2017-update.pdf

B.C. – Ministry of Mental Health & Addictions. (n.d.). Consulted on October 15, 2018: https://www2.gov.bc.ca/gov/content/governments/organizational-structure/ministries-organizations/ministries/mental-health-addictions

B.C. – Ministry of Mental Health and Addictions. (2018). 2018/19 – 2020/21 Service Plan. British Columbia: Government of British Columbia. Retrieved from: http://bcbudget.gov.bc.ca/2018/sp/pdf/ministry/mh.pdf

B.C. – Provincial Health Services Authority. (2018). Who we are. Our Unique Role. Consulted on October 15, 2018: http://www.phsa.ca/about/who-we-are/our-unique-role

First Nations Health Authority. (2018). About Us. Consulted on November 19, 2018: http://www.fnha.ca/about

Manitoba

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

MANITOBA

PROVINCIAL LEVEL

Manitoba Health, Seniors and Active Living

Manitoba Health, Seniors and Active Living “operates under the provisions of the legislation and responsibilities of the Minister of Health, Seniors and Active Living. The legislation, as well as emerging health and health care issues, guide the planning and delivery of health care services for Manitobans […] Manitoba Health, Seniors and Active Living strives ‘…to meet the health needs of individuals, families and their communities by leading a sustainable, publicly administered health system that promotes well-being and provides the right care, in the right place, at the right time.’” (Manitoba – Health, Seniors and Active Living, n.d.-a).

In addition to the existence of the Office of the Chief Provincial Public Health Officer, within Manitoba Health, Seniors and Active Living, the responsibility for public health falls to the division of Active Living, Indigenous Relations, and Population and Public Health (Manitoba – Health, Seniors and Active Living, 2017, p. 12). “Manitoba Public Health aims to provide the leadership and coordination for an integrated approach to public health programs and services” (Manitoba – Health, Seniors and Active Living, n.d. -b). The goal of Manitoba Public Health is to “focus on the prevention and control of diseases and the promotion of health” (Manitoba – Health, Seniors and Active Living, n.d.-b). This division is comprised of the following branches: Communicable Disease Control, Environmental Health, Epidemiology and Surveillance (Manitoba – Health, Seniors and Active Living, n.d.-b).

An organizational chart for Manitoba Health, Seniors and Active Living is available below.

REGIONAL LEVEL

There are five regional health authorities:

Interlake-Eastern Regional Health Authority
Northern Regional Health Authority
Southern Health/Santé Sud
Prairie Mountain Health
Winnipeg Regional Health Authority (Manitoba – Health, Seniors and Active Living, n.d.-c).

A map of Manitoba’s regional health authorities is available below.

The Regional Health Authorities Act, enacted in 1996, defines the duties and responsibilities of the Regional Health Authorities. In addition, a “regional health authority is responsible for the delivery and administration of public health services in its health region in accordance with … [The Public Health Act] and any guidelines and standards established by the minister” (The Public Health Act, 2006, Section 6).

“Health authority boards are accountable to the Minister of Health, Seniors and Active Living and are responsible for the mandate, resources and performance of the health authority” (Manitoba – Health, Seniors and Active Living, n.d.-c).

CHIEF PROVINCIAL PUBLIC HEALTH OFFICER

Dr. Michael Isaac is the acting Chief Provincial Public Health Officer for Manitoba while a competition for a permanent replacement is underway (Manitoba – Health, Seniors and Active Living, 2018; Personal communication, October 9, 2018).

According to the Public Health Act, “The minister must appoint a physician as chief provincial public health officer in accordance with the regulations” who is responsible for “advising the minister about public health issues” (The Public Health Act, 2006, Section 10; Section 11.1).

As such, the Chief Provincial Public Health Officer has direct reporting responsibility to the Deputy Minister of Health, Seniors and Active Living, and an advisory and legislated role in overseeing the health of the population and protecting public health. The office works closely with the staff in the Active Living, Indigenous Relations, Population and Public Health Branch of Manitoba Health, Seniors and Active Living (Personal communication, October 9, 2018).

The main responsibilities of the Chief Provincial Public Health Officer comprise the following:

“To monitor and report on the health status of Manitobans.
To support government departments and other partners to improve the overall health of Manitobans and reduce health disparities.
To take appropriate action consistent with the powers and responsibilities described for the Chief Provincial Public Health Officer (CPPHO) in the Public Health Act.
To advance public health knowledge and capacity” (Manitoba – Health, Seniors and Active Living, n.d.-d).

REFORMS

2012 – Restructuration of Regional Health Authorities

The Manitoba government reduces the number of regional health authorities from eleven to five (Government of Manitoba, 2012).

2009 – Public Health Act

The new Public Health Act comes into effect, providing a legislative framework for anticipating and responding to public health emergencies. It also creates a framework for other provincial public health functions, such as health surveillance, disease and injury prevention, and population health assessments (Manitoba – Health, Seniors and Active Living, n.d.-e).

REFERENCES

Government of Manitoba. (2012, May 30). Province announces 11 Regional Health Authorities officially merged into five new regions. News Release. Retrieved from: http://news.gov.mb.ca/news/index.html?item=14394

Manitoba – Health, Seniors and Active Living. (n.d.-a). About the Department. Consulted on 12 October, 2018: https://www.gov.mb.ca/health/about.html

Manitoba – Health, Seniors and Active Living. (n.d.-b). Public Health. Consulted on 12 October, 2018: http://www.gov.mb.ca/health/publichealth/index.html

Manitoba – Health, Seniors and Active Living. (n.d.-c). Regional Health Authorities in Manitoba. Consulted on 12 October, 2018: http://www.gov.mb.ca/health/rha/index.html

Manitoba – Health, Seniors and Active Living. (n.d.-d). Office of the Chief Provincial Public Health Officer. Consulted on 12 October, 2018: https://www.gov.mb.ca/health/cppho/index.html

Manitoba – Health, Seniors and Active Living. (n.d.-e). The Public Health Act. Consulted on 12 October, 2018: https://www.gov.mb.ca/health/publichealth/act.html

Manitoba – Health, Seniors and Active Living. (2017). Annual report 2016-2017. Retrieved from: https://www.gov.mb.ca/health/ann/docs/1617.pdf

Manitoba – Health, Seniors and Active Living. (2018). Medical Officers of Health – Contact List. Consulted on 12 October, 2018: http://www.gov.mb.ca/health/publichealth/contactlist.html

The Public Health Act, 2006, C.C.S.M. c. P210. Retrieved from: http://web2.gov.mb.ca/laws/statutes/ccsm/p210e.php

New Brunswick

This text includes excerpts from government websites and official publications. Websites and publications from other relevant organizations were also consulted. These have been supplemented by information from key provincial or territorial stakeholders, whenever relevant (cited as personal communication within the text). Certain recent changes or updated responsibilities may not be reflected in this document as it is primarily based on information available online.

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

NEW BRUNSWICK

PROVINCIAL LEVEL

Department of Health

Briefly, the role of the Department of Health is to “plan, fund and monitor the health-care system” (N.B. – Health, 2017, p. 3). Within the Department of Health, the Office of the Chief Medical Officer of Health is responsible for the overall direction of public health programming across the province (N.B. – Health, 2018).

In addition, the Health Analytics Branch supports the department in enhancing the use of analytic tools, methods and metrics to plan, implement and measure improvements in patient care experiences, population health and focused health system investments (Personal communication, November 1, 2018).

The organizational structure of the Department of Health can be viewed below.

Department of Social Development

The mission of the Department of Social Development involves offering programs and services to “Provide greater independence, an improved quality of life and protection for those in need” (N.B. – Department of Social Development, 2016, p. 5).

Within the Department of Social Development, the Wellness Branch has the mandate to improve population health. This includes the development of “a provincial Wellness Strategy which includes increasing physical activity, promoting healthy eating, promoting mental fitness and resilience and promoting tobacco-free living” (N.B. – Social Development, 2018).

The strategic directions of the Wellness Branch include community development, promotion of healthy lifestyles, healthy policies, partnerships and collaboration, and surveillance/evaluation/research (N.B. – Social Development, 2018).

The Branch’s role also includes “provid[ing] effective leadership and direction, meaningful support, target monitoring, and, where appropriate, strategic intervention in partnership with provincial, regional and local organizations. The Branch also develops strategic partnerships with other provincial and federal governments and agencies to ensure wellness initiatives are strategically aligned with other efforts” (N.B. – Social Development, 2018).

The organizational structure of the Department of Social Development can be viewed below.

Department of Justice and Public Safety

Department of Environment and Local Government

In addition, the Department of Justice and Public Safety and the Department of Environment and Local Government also have a public health portfolio (Personal communication, November 1, 2018).

REGIONAL LEVEL

New Brunswick has two regional health authorities:

Horizon Health Network
Vitalité Health Network

In 2008, the “Government of New Brunswick transitioned to two Regional Health Authorities (RHAs) from the previous eight RHAs. The two RHAs have a broad mandate to deliver health services within New Brunswick. Each RHA has a Board of Directors appointed by the Minister of Health” (Government of New Brunswick, 2018a).

“The two RHAs are responsible for managing and delivering a variety of services including Hospital Services, Community Health Centre Services, Extra Mural Services, Addictions and Mental Health Services and most Public Health Services” (Government of New Brunswick, 2018a).

The following is a map of the various health zones covered by Horizon Health Network and Vitalité Health Network.

CHIEF MEDICAL OFFICER OF HEALTH

The Chief Medical Officer of Health is Dr. Jennifer Russell (Government of New Brunswick, 2018b).

As stipulated in the Public Health Act, the Minister appoints a chief medical officer of health for the province (Public Health Act, 1998, section 59.1). “The mission of the Office of the Chief Medical Officer of Health (OCMOH) is to improve, promote, and protect the health of the people of New Brunswick. It is responsible for the overall direction of public health programs in [the] province and works collaboratively with Public Health staff in the regional health authorities and other government and non-government health-care providers” (N.B. – Health, 2018).

REFORMS

2018 – Public Health Inspector Certification Regulation

This regulation under the Public Health Act updates the certification requirements of public health inspectors (New Brunswick Regulation under the Public Health Act, 2018).

2018 – Amendments to the Public Health Act

A variety of housekeeping amendments are made and new sections are added: Chief medical officer of health to monitor and report on public health (section 61.1) and General authority of medical officers of health to protect health and well-being (section 61.2) (Personal communication, November 1, 2018).

2017 – Restructuring the Office of the Chief Medical Officer of Health

The Government of New Brunswick is restructuring the Office of the Chief Medical Officer of Health, shifting some of its daily operations to other departments, including the Department of Justice and Public Safety, the Department of Social Development, and the Department of Environment and Local Government (Pruss, 2017).

2009 – Changes to Public Health Act

Significant changes are made to the Public Health Act in order to strengthen the public health system, including the addition of new regulations to assist public health professionals in mitigating health hazards, the provision of additional authority to assist in the control and elimination of communicable diseases, and the addition of enforcement provisions to assist in carrying out these additional responsibilities (N.B. – Health, 2009).

2008 – Reorganization of Regional Health Authorities

The Government of New Brunswick transitions to two regional health authorities (RHAs) from the previous eight RHAs (Government of New Brunswick, 2018a).

REFERENCES

Government of New Brunswick. (2018a). Regional Health Authorities. Consulted on November 12, 2018: http://www2.gnb.ca/content/gnb/en/services/services_renderer.9435.Regional_Health_Authorities.html

Government of New Brunswick. (2018b). Contacts. Consulted on November 12, 2018: http://www2.gnb.ca/content/gnb/en/contacts/contacts_renderer.211922.html

N.B. – Health. (2009, November 9). New Public Health Act, regulations come into force. News release. Retrieved from: http://www.gnb.ca/cnb/news/he/2009e1856he.htm

N.-B. – Health. (2017). Annual Report 2016–2017. Retrieved from http://www2.gnb.ca/content/dam/gnb/Departments/h-s/pdf/en/Publications/AnnualReport_2016-2017.pdf

N.B. – Health. (2018). Mandates. Consulted on November 12, 2018: http://www2.gnb.ca/content/gnb/en/departments/ocmoh/contacts/dept_renderer.141.html#mandates

N.B. – Social Development. (2016). Together We Thrive. Strategic Plan 2016-2021. Retrieved from https://www2.gnb.ca/content/dam/gnb/Departments/sd-ds/pdf/Departmental/TogetherWeThrive.pdf

N.B. – Social Development. (2018). Mandate. Consulted on November 12, 2018: http://www2.gnb.ca/content/gnb/en/departments/social_development/contacts/dept_renderer.140.html#mandates

New Brunswick Regulation under the Public Health Act, 2018. Retrieved from https://www.gnb.ca/0062/acts/BBR-2018/2018-9.pdf

Pruss, V. (2017, August 31). Province restructures Office of Chief Medical Officer of Health. CBC News. Retrieved from:
https://www.cbc.ca/news/canada/new-brunswick/department-health-chief-officer-medical-new-brunswick-changes-1.4270786

Public Health Act, 1998, C-22.4. Retrieved from: https://www.gnb.ca/legis/business/pastsessions/53/53-3/status-e/bills/056-e.asp

Newfoundland and Labrador

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

NEWFOUNDLAND AND LABRADOR

PROVINCIAL LEVEL

Department of Health and Community Services

The mandate of the Department of Health and Community Services comprises the provision of “leadership, coordination, monitoring and support to the regional health authorities and other entities who deliver programs and services ensuring quality, efficiency and effectiveness in the following areas:

The preservation and promotion of health;
The prevention and control of disease;
Public health and the enforcement of public health standards;
The administration of health care facilities;
Access and clinical efficiency;
Programs for seniors, persons with disabilities and persons with mental health and addictions issues as well as long-term care and community support services;
Health professional education and training programs; and
The control, possession, handling, keeping and sale of food and drugs.” (NL – Department of Health and Community Services, n.d.-a, p. 31)

Within the Department of Health and Community Services, the Population and Public Health Division is responsible for public health surveillance, immunization, infection control, environmental health, communicable diseases and emergency preparedness (Personal communication, September 18, 2018). The Population and Public Health Division also works closely with other divisions within the department, including the Mental Health and Addictions Division, to deliver public health policies and programming (Personal communication, September 18, 2018).

Department of Children, Seniors and Social Development

Service NL

Two other provincial departments also fulfill certain public health functions (Personal communication, September 18, 2018).

The Department of Children, Seniors and Social Development focuses on health promotion and wellness (NL – Children, Seniors and Social Development, 2018). Service NL delivers environmental health services, primarily through the functions of environmental health officers (Service NL, 2018).

REGIONAL LEVEL

Four regional health authorities (RHAs) are responsible for planning, funding and managing health and community services across the province (Bergevin, et al., 2016, p. 7; NL – Department of Health and Community Services, 2018):

Eastern Regional Health Authority
Central Regional Health Authority
Western Regional Health Authority
Labrador-Grenfell Regional Health Authority

More specifically, the mandate of the four regional health authorities includes delivery of health and community prevention and promotion; road ambulance services; health and community protection; continuing care; mental health; addiction services; child, youth and family services; and services to adult individuals (Regional Integrated Health Authorities Order, 2005, Section 2.2).

The RHAs are governed by the Regional Health Authorities Act (Institute of Public Administration of Canada, 2013).

CHIEF MEDICAL OFFICER OF HEALTH

The Acting Chief Medical Officer of Health (CMOH) is Dr. Claudia Sarbu (Government of Newfoundland and Labrador, 2018a).

A key role of the Chief Medical Officer of Health is to advise the Assistant Deputy Minister, the Deputy Minister, and the Minister of Health and Community Services on public health issues. The role of the CMOH also involves communicating with professionals, the public, and the media on public health issues. In addition, the CMOH assumes a leadership role within the public health system, as well as a managerial role within the Population and Public Health Division of the Department of Health and Community Services. In turn, the CMOH reports to the Assistant Deputy Minister of Health and Community Services (Personal communication, September 18, 2018).

The Public Health Protection and Promotion Act frames the functions of the CMOH (Public Health Protection and Promotion Act, 2018).

REFORMS

2018 – New Public Health Legislation

A new Public Health Protection and Promotion Act is drafted to revise the present law respecting communicable diseases, health hazards, health promotion, disease and injury prevention and population health. More specifically, it will repeal the Communicable Diseases Act and certain sections of the Health and Community Services Act. This Act will come into force on July 1, 2019 (Public Health Protection and Promotion Act, 2018).

2017 – Reorganization of Public Health Division

During 2016-17 fiscal year, the Public Health Division of the Department of Health and Community Services underwent significant reorganization (NL – Department of Health and Community Services, n.d.-b, p.33).

2016-2017 – Creation of a Health-in-all-Policies Unit

A Health-in-all-Policies Unit is created within the Department of Health and Community Services. This Unit works with governmental departments to integrate health considerations into policy development with the long-term goal of improving health outcomes for the population of Newfoundland and Labrador (Government of Newfoundland and Labrador, n.d.).

2014 – Department of Seniors, Wellness and Social Development

The Department of Seniors, Wellness and Social Development (now known as the Department of Children, Seniors and Social Development) is created. The following divisions are removed from the Department of Health and Community Services and moved to the new department: 1) Health Promotion and Wellness; 2) Healthy Aging and Seniors; and 3) Support to Community Agencies (NL – Department of Health and Community Services, n.d.-c, p.2).

2012 – Restructuring of Department of Health and Community Services

The Population Health Branch of the Department of Health and Community Services is formally structured with an appointed associate deputy minister (NL – Department of Health and Community Services, n.d.-d, p.8).

REFERENCES

Bergevin, Y., Habib, B., Elicksen, K., Samis S., Rochon, J., Adaimé, C., … Roy, D. (2016). Towards the Triple Aim of Better Health, Better Care and Better Value for Canadians: transforming regions into high performing health systems. Ottawa: Canadian Foundation for Healthcare Improvement. Retrieved from: https://www.cahspr.ca/web/uploads/conference/2016-03-31_Regionalization_Report.pdf

Government of Newfoundland and Labrador. (n.d.). Take a Health-in-All-Policies Approach. Consulted on October 22, 2018 : https://www.gov.nl.ca/thewayforward/action/adopt-a-health-in-all-policies-approach/

Government of Newfoundland and Labrador. (2018a). Telephone Directory. Consulted on October 22, 2018: http://telephonedirectory.gov.nl.ca/Details/Default.aspx?id=26463

Government of Newfoundland and Labrador. (2018b, March 6). Residents Encouraged to Provide Input on New Public Health Legislation. News release. Retrieved from: http://www.releases.gov.nl.ca/releases/2018/health/0306n05.aspx

Institute of Public Administration of Canada. (2013). Healthcare Governance Models in Canada: A Provincial Perspective: Healthcare Governance Pre-summit Discussion Paper. Toronto: The Institute of Public Administration of Canada. Retrieved from: http://neltoolkit.rnao.ca/sites/default/files/Healthcare%20Governance%20Models%20in%20Canada_A%20Provincial%20Perspective_Pre-Summit%20Disscussion%20Paper%20March%202013.pdf

NL – Department of Health and Community Services. (n.d.-a). Annual Performance Report for 2015-2016. Retrieved from: https://www.health.gov.nl.ca/health/publications/pdf/HCS_AR_2015_16.pdf

NL – Department of Health and Community Services. (n.d.-b). Annual Report 2016-2017. Retrieved from: https://www.health.gov.nl.ca/health/publications/pdf/HCS_AR_2016_17.pdf

NL – Department of Health and Community Services. (n.d.-c). Annual Report 2014-2015. Retrieved from: https://www.health.gov.nl.ca/health/publications/pdf/hcs_annual_report_2015.pdf

NL – Department of Health and Community Services. (n.d.-d). Department of Health and Community Services Annual Report 2011-2012. Retrieved from: https://www.health.gov.nl.ca/health/publications/DHCS_AnnualReport2011-2012.pdf

NL – Department of Health and Community Services. (2018). Services in Your Region. Consulted on October 22, 2018: http://www.health.gov.nl.ca/health/findhealthservices/in_your_community.html

NL – Children, Seniors and Social Development. (2018). About the Department. Consulted on October 22, 2018: https://www.cssd.gov.nl.ca/department/index.html

Public Health Protection and Promotion Act. (2018). Retrieved from https://assembly.nl.ca/HouseBusiness/Bills/ga48session3/bill1837.htm

Regional Integrated Health Authorities Order under the Hospitals Act. 2005, Regulation 18/05. Retrieved from http://www.assembly.nl.ca/legislation/sr/annualregs/2005/Nr050018.htm

Service NL. (2018). Food Establishment Inspections. Consulted on October 22, 2018: https://www.servicenl.gov.nl.ca/inspections/index.html

Québec

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

QUÉBEC

PROVINCIAL LEVEL

Department of Health and Social Services

At the provincial level, public health is primarily a responsibility of the Department of Health and Social Services (Ministère de la Santé et des Services sociaux) through the Public Health Departmental Branch (Direction générale de la santé publique).

The mission of the Department of Health and Social Services is “to maintain, improve and restore the health and well-being of Quebecers by providing access to a range of quality and integrated health and social services, thereby contributing to the social and economic development of Québec” (Ministère de la Santé et des Services sociaux du Québec, 2018a).

Since 1993, the Department of Health and Social Services has included a Public Health Departmental Branch headed by an assistant deputy minister (Gagnon, Turgeon & Dallaire, 2008). This Branch comprises three sub-directorates: the public health sub-directorate, the health prevention and promotion sub-directorate and the public health protection sub-directorate, within which are several sub-divisions and units (Ministère de la Santé et des Services sociaux du Québec, 2018b).

For more information, refer to the Department of Health and Social Services’ organizational chart below (available in French).

National Public Health Institute of Quebec (Institut national de santé publique du Québec)

The Institut national de santé publique du Québec was created in 1998 by the Act respecting Institut national de santé publique du Québec. Its mission “is to support Québec’s Minister of Health and Social Services, regional public health authorities, and health and social services institutions in carrying out their public health responsibilities, by offering […] expertise and specialized laboratory and screening services” (Institut national de santé publique du Québec, 2018).

Politique gouvernementale de prévention en santé

In 2016, the government of Québec launched its first preventive health policy. This policy is the result of a collaboration between the Department of Health and Social Services and numerous partners, representing various sectors, and working at all levels of government. By means of its broad cross-sectoral approach, this policy proposes acting in a coordinated manner on a set of factors to improve the health status and quality of life of the population of Québec and reduce social inequalities of health (Ministère de la Santé et des Services sociaux du Québec, 2018c).

More than 15 departments and agencies worked together closely on an initial inter-ministerial action plan covering the period 2017-2021. This is to serve as the main tool for planning and organizing the first phase of implementation of the government preventive health policy (Ministère de la Santé et des Services sociaux du Québec, 2018d).

REGIONAL LEVEL

The regional health and social services agencies were abolished in 2015 (Ministère de la Santé et des Services sociaux du Québec, 2018e), while the functions of the 18 regional public health authorities remained unchanged (including the. Cree Board of Health and Social Services of James Bay) (Ministère de la Santé et des Services sociaux du Québec, 2019).

In accordance with the Act to Modify the Organization and Governance of the Health and Social Services Network, in Particular by Abolishing the Regional Agencies, new regional institutions were created in each socio-sanitary region (with two exceptions) through the fusion of the regional agency and the majority of health and social services in a given region (Ministère de la Santé et des Services sociaux du Québec, 2018e), while the functions of the 18 regional public health authorities remained unchanged (including the. Cree Board of Health and Social Services of James Bay) (Ministère de la Santé et des Services sociaux du Québec, 2019).

This reorganization reduced the number of health and social services institutions from 182 to 34: 13 integrated health and social services centres (CISSS), 9 integrated university health and social services centres (CIUSSS), 7 non-merged institutions including university hospitals (except the CHU de Sherbrooke) as well as academic institutions, and 5 non-target institutions serving a northern and Indigenous population (Ministère de la Santé et des Services sociaux du Québec, 2018e, 2018f).

The roles and responsibilities of each CISSS and CIUSSS include:

“be responsible for the delivery of care and services to the population of its health and social service territory, including the public health component;
assume populational responsibility for their health and social territory’s population;
organize the core and complementary services in its territory as part of its multiple missions […] based on the needs of its population and its territorial realities; and
enter into agreements with other institutions and partner organizations of the RTS [territorial service network] (such as university hospital centres, medical clinics, family medicine groups, network clinics, community organizations, community pharmacies and external partners)” (Ministère de la Santé et des Services sociaux du Québec, 2018e).

For more information, consult the following diagram representing the new organization of the health and social services network.

“The public health authority works to promote the health and well-being of the population, prevent health problems and social problems, protect health and the population, and reduce social inequalities in health” [translated from Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2018]. The services available are described in a regional public health action plan, aligned with the National Public Health Program (Programme national de santé publique) and the local characteristics of the region’s population (Public Health Act, 2001).

In addition, the Department of Health and Social Services must “ensure the organization and delivery of public health functions (promotion, prevention, monitoring and protection) and assume the coordination of services in this area with the regional public health directors” (Ministère de la Santé et des Services sociaux du Québec, 2018e).

NATIONAL PUBLIC HEALTH DIRECTOR/ASSISTANT DEPUTY MINISTER OF PUBLIC HEALTH

In 2001, the position of national public health director was created. This individual assumes both administrative responsibilities, as assistant deputy minister for the Public Health Departmental Branch (Direction générale de la santé publique) and professional responsibilities, as the national director (Act respecting the Ministère de la Santé et des Services sociaux, 1985, section 5.1). Dr. Horacio Arruda currently fulfills these roles within the Department (Ministère de la Santé et des Services sociaux du Québec, 2018b).

The national public health director advises the Minister during emergency situations, is responsible for the Public Health Departmental Branch within the Department of Health and Social Services, coordinates the National Public Health Program (Programme national de santé publique du Québec) with the regional public health directors, and promotes intersectoral action in public health (Ministère de la Santé et des Services sociaux du Québec, 2015, p.31-32). Additionally, “The Minister may delegate to the national public health director functions or powers granted to the Minister under the Public Health Act” (Act respecting the Ministère de la Santé et des Services sociaux, 1985, section 5.1).

REFORMS

2015 – Reorganization of Health and Social Services Network

The Act to modify the organization and governance of the health and social services network, in particular by abolishing the regional agencies is adopted. This Act delineates a reorganization whose aim is to delegate the majority of health and social services within a territorial service network to either an integrated health and social services centre (CISSS) or to an integrated university health and social services centre (CIUSSS). This recent restructuring of the network has eliminated the regional health and social services agencies (Ministère de la Santé et des Services sociaux du Québec, 2018g).

2001 – Public Health Act

The Public Health Act is adopted. It provides a legislative framework for public health activities, including health surveillance, disease prevention and the protection of health, in particular in the event of a public health emergency. This Act also sets out the requirement for a National Public Health Program (section 7) that must be broken down into regional and local public health plans (sections 11 and 14). In addition, section 54 requires all departments to assess the potential impact of their policies on the health of the population. Health impact assessment is the mechanism that has been institutionalized by the Department of Health and Social Services for the purpose of implementing this section of the Act (Ministère de la Santé et des Services sociaux du Québec, 2005; Public Health Act, 2001).

REFERENCES

Act respecting Institut national de santé publique du Québec, 1998, chapter I-13.1.1. Retrieved from: http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=/I_13_1_1/I13_1_1_A.html

Act respecting the Ministère de la Santé et des Services sociaux, 1985, chapter M-19.2. Retrieved from: http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=/M_19_2/M19_2_A.html

Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale. (2018). Santé publique. Consulted on October 17, 2018: https://www.ciusss-capitalenationale.gouv.qc.ca/expertise-et-partenariat/sante-publique

Gagnon, F., Turgeon, J., & Dallaire, C. (2008). L’évaluation d’impact sur la santé au Québec: lorsque la loi devient levier d’action. Télescope. Retrieved from: http://www.telescope.enap.ca/Telescope/docs/Index/Vol_14_no_2/Telv14n2_gagnon_al.pdf

Institut national de santé publique du Québec. (2018). About us. Consulted on October 17, 2018: https://www.inspq.qc.ca/en/institute/about-us

Ministère de la Santé et des Services sociaux du Québec. (2005). Article 54 de la Loi sur la santé publique. Bilan de mise en œuvre. Québec: Gouvernement du Québec. Retrieved from: http://politiquespubliques.inspq.qc.ca/fichier.php/60/Bilanarticle54.pdf

Ministère de la Santé et des Services sociaux du Québec. (2015). Programme nationale de santé publique 2015-2025. Québec: Gouvernement du Québec. Retrieved from: http://publications.msss.gouv.qc.ca/msss/fichiers/2015/15-216-01W.pdf

Ministère de la Santé et des Services sociaux du Québec. (2019). Coordonnées des directeurs de santé publique. Consulted on January 28, 2019: http://www.msss.gouv.qc.ca/professionnels/documents/liste-directeurs-santepub.pdf

Ministère de la Santé et des Services sociaux du Québec. (2018a). Mission. Consulted on October 17, 2018: http://www.msss.gouv.qc.ca/en/ministere/mission/

Ministère de la Santé et des Services sociaux du Québec. (2018b). Organisation administrative. Organigramme du Ministère. Consulted on October 17, 2018: http://www.msss.gouv.qc.ca/ministere/poa/index.php

Ministère de la Santé et des Services sociaux du Québec. (2018c). Politique gouvernementale de prévention en santé. Consulted on October 18, 2018 : http://publications.msss.gouv.qc.ca/msss/document-001753/

Ministère de la Santé et des Services sociaux du Québec. (2018d). Plan d’action interministériel 2017-2021 de la Politique gouvernementale de prévention en santé. Consulted on October 18, 2018 : http://publications.msss.gouv.qc.ca/msss/document-002035/

Ministère de la Santé et des Services sociaux du Québec. (2018e). Network Reorganization. Organizational profile. Consulted on October 17, 2018: http://www.msss.gouv.qc.ca/en/reseau/reorganisation/portrait-organisationnel/

Ministère de la Santé et des Services sociaux du Québec. (2018f). Health and Social Services System in Brief. Governance and service organization. Consulted on October 17, 2018: http://www.msss.gouv.qc.ca/en/reseau/systeme-de-sante-et-de-services-sociaux-en-bref/gouvernance-et-organisation-des-services/

Ministère de la Santé et des Services sociaux du Québec. (2018g). Network Reorganization. Context. Consulted on October 17, 2018: http://www.msss.gouv.qc.ca/reseau/reorganisation/portrait-organisationnel/

Public Health Act, L.R.Q. 2001, chapter S-2.2. Retrieved from: http://legisquebec.gouv.qc.ca/en/pdf/cs/S-2.2.pdf

Northwest Territories

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

NORTHWEST TERRITORIES

TERRITORIAL LEVEL

Department of Health and Social Services

“The Department of Health and Social Services promotes, protects and provides for the health and well being of the people of the Northwest Territories” (NWT – Department of Health and Social Services, n.d.). Its functions include “setting the strategic direction for the system through the development of legislation, policy and standards; the establishment of approved programs and services; the establishment and monitoring of system budgets and expenditures; and evaluating and reporting on system outcomes and performance” (Government of Northwest Territories, 2018a, p. 8).

Within the Department of Health and Social Services, the Office of the Chief Public Health Officer is responsible for public health (Government of Northwest Territories, 2018b).

See the following organizational chart of the Department of Health and Social Services below.

Northwest Territories Health and Social Services Authority

“The Northwest Territories Health and Social Services Authority (NTHSSA) is responsible for the design and delivery of territorial health and social services planning across the Northwest Territories” (N.W.T. Health and Social Services Authority, n.d.-a).

The NTHSSA was established on August 1^st 2016, prior to which there were eight independent health and social services authorities across the Northwest Territories. The NTHSSA is an amalgamation of six regional health authorities (Beaufort Delta, Sahtu, Dehcho, Fort Smith, Yellowknife, and Stanton Territorial Hospital). First Nations self-government agreements are respected through the establishment of Regional Wellness Councils. The chair of each seven person council sits on the NTHSSA Leadership Council which serves as the Board of Management for the NTHSSA (N.W.T. Health and Social Services Authority, n.d.-b; Personal communication, October 10, 2018).

The Hay River Health and Social Services Authority (HRSSA) continues to operate under its own board of management until negotiations can be completed to incorporate it into the public service (N.W.T. Health and Social Services Authority, n.d.-b).

“The Tlicho Community Services Agency (TCSA) will continue to be a Board of Management under the Hospital Insurance and Health and Social Services Administration Act and will continue to deliver health and social services in Tlicho Communities. The establishment of the new Authority will respect the legislation that establishes the TCSA which was implemented as a result of the Tlicho Self Government Agreement” (N.W.T. Health and Social Services Authority, n.d.-a).

“Most importantly, the NTHSSA, the HRSSA and the TCSA will become part of one integrated territorial health and social services system functioning together under a one-system-approach and under a single governance structure” (Government of Northwest Territories, 2017, p. 7).

REGIONAL LEVEL

Prior to the creation of the Northwest Territories Health and Social Services Authority (NTHSSA) on August 1st 2016, eight independent health and social services authorities existed across the Northwest Territories (N.W.T. Health and Social Services Authority, n.d.-a). “To organize the delivery of care and services in the territory the Northwest Territories Health and Social Services Authority is coordinated in regional operations” (N.W.T. Health and Social Services Authority, n.d.-c).

The Hay River Health and Social Services Authority and the Tlicho Community Services Agency continue to deliver public health services on their territories (N.W.T. Health and Social Services Authority, n.d.-a; Personal communication, January 30, 2019).

CHIEF PUBLIC HEALTH OFFICER

Dr. Kami Kandola was named the new Chief Public Health Officer for the Northwest Territories effective October 1, 2018 (Government of Northwest Territories, 2018).

The duties and responsibilities of the Chief Public Health Officer, outlined within the Public Health Act, include issuing public health advisories and bulletins, ensuring the safety of food and drinking water, maintaining registries of reportable diseases, and declaring public health emergencies (Public Health Act, 2007).

The Office of the Chief Public Health Officer is comprised of two divisions: the Aboriginal Health and Community Wellness Division and the Population Health Division. The former has a health and wellness promotion portfolio, and works primarily on anti-poverty initiatives, early childhood development initiatives, community wellness initiatives, and ensuring a culturally respectful health and social services system. The latter comprises an Environmental Health Unit, a Communicable Disease Control Unit, an Epidemiology and Surveillance Unit and a Public Health Registries Unit (Government of Northwest Territories, 2018b, n.d.).

REFORMS

2016 – An Act to Amend the Hospital Insurance and Health and Social Services Administration Act

Under An Act to Amend the Hospital Insurance and Health and Social Services Administration Act, the Northwest Territories Health and Social Services Authority is established to replace the regional health authorities (N.W.T. Health and Social Services Authority, n.d.-a; An Act to Amend the Hospital Insurance and Health and Social Services Administration Act, 2015).

2009 – Update of the Public Health Act

The new Public Health Act repeals the 1988 Public Health Act and the 1988 Disease Registries Act. The title of the Chief Medical Health Officer is changed to Chief Public Health Officer (CPHO). The Act details the powers and responsibilities of the CPHO with respect to health protection, drinking water safety, health surveillance and reportable diseases, public health emergencies, and personal health information; permits the CPHO to appoint Deputy CHPOs; and requires the CPHO to establish and maintain a registry of notifiable immunizations (Public Health Act, 2007).

REFERENCES

An Act to Amend the Hospital Insurance and Health and Social Services Administration Act, 2015. Retrieved from: https://www.assembly.gov.nt.ca/sites/default/files/bill_44_-_hospital_insurance_and_hss_administration_a_-_reprint.pdf

Government of Northwest Territories. (n.d.). Department Organization Charts. Health and Social Services. Consulted on October 11, 2018: http://rdirectory.gov.nt.ca/rDirectory.aspx

Government of Northwest Territories (2017). Caring for Our People: Strategy Plan for the NWT Health and Social Services System 2017 to 2020. Retrieved from: https://www.hss.gov.nt.ca/sites/hss/files/resources/caring-our-people-strategic-plan-2017-2020.pdf

Government of Northwest Territories. (2018a). NWT Health and Social Services System Annual Report 2016-2017. Retrieved from https://www.hss.gov.nt.ca/sites/hss/files/resources/hss-annual-report-2016-17.pdf

Government of Northwest Territories. (2018b). Health and Social Services Organizational Chart. Consulted on October 11, 2018: https://www.fin.gov.nt.ca/sites/fin/files/49-health_and_social_services_-_sept._26_2018_-_website.pdf

Government of Northwest Territories (2018, October 1). New Chief Public Health Officer Named. News Release. Retrieved from: https://www.gov.nt.ca/en/newsroom/new-chief-public-health-officer-named

N.W.T. – Department of Health and Social Services. (n.d.). About us. Consulted on October 11, 2018: http://www.hss.gov.nt.ca/en/about-us

N.W.T. – Health and Social Services Authority. (n.d.-a). About us. Consulted on October 11, 2018: https://www.nthssa.ca/en/about-us

N.W.T. – Health and Social Services Authority. (n.d.-b). FAQ. Consulted on October 11, 2018: https://www.nthssa.ca/en/faq

N.W.T. – Health and Social Services Authority. (n.d.-c). Regions. Consulted on February 13, 2019: https://www.nthssa.ca/en/regions

Public Health Act, S.N.W.T. 2007, c. 17. Retrieved from: https://www.justice.gov.nt.ca/en/files/legislation/public-health/public-health.a.pdf

Nova Scotia

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

NOVA SCOTIA

PROVINCIAL LEVEL

Department of Health and Wellness

Briefly, the Department of Health and Wellness is responsible for setting strategic directions, priorities and standards, and providing leadership for the health system, as well as measuring and monitoring health-system performance (N.S. – Health and Wellness, 2017a, p. 2). “The health and wellness system includes the delivery of health care as well as the prevention of disease and injury and the promotion of health and healthy living” (N.S. – Health and Wellness, 2017a, p. 2).

As such, public health in Nova Scotia is the responsibility of the Department of Health and Wellness. “The Department of Health and Wellness leads this work, in collaboration with district health authorities, communities, citizens, experts, and other government departments” (N.S. – Health and Wellness, 2018a).

Accountabilities for public health within the Department of Health and Wellness rest with the following divisions: Office of the Chief Medical Officer of Health, Investment Decision and Support Division, and Risk Management-Health Promotion Branch (Personal communication, October 24, 2018).

Department of Environment

Accountabilities for environmental public health programs rest with the Department of Environment, including the work of public health officers (public health inspectors) (N.S. – Health and Wellness, 2018b).

Nova Scotia Health Authority

On April 1, 2015, all nine district health authorities were amalgamated into the Nova Scotia Health Authority, which partnered with the Izaak Walton Killam Health Centre to launch a new health system structure (N.S. – Health and Wellness, 2018c).

“Nova Scotia Health Authority provides health services to Nova Scotians and some specialized services to Maritimers and Atlantic Canadians” (Nova Scotia Health Authority, 2017). This includes the operation of “hospitals, health centres and community-based programs across the province” (Nova Scotia Health Authority, 2017).

The Nova Scotia Health Authority is accountable for operationalizing public health strategies, priorities and standards established by the Department of Health and Wellness. Current areas of focus in public health programming include: early childhood, healthy communities, and health protection. Within these areas of focus, multi-disciplinary teams work to fulfill the core functions of public health, including health promotion, health protection, population health surveillance, and disease and injury prevention (Personal communication, October 24, 2018).

As with all health services, public health is organized across four geographic management areas within the Nova Scotia Health Authority:

Annapolis Valley, South Shore and South West Nova Scotia
Cape Breton, Guysborough and Antigonish areas
Colchester-East Hants, Cumberland and Pictou areas
Halifax, Eastern Shore and West Hants (N.S. – Health and Wellness, 2018c)

Nova Scotia Public Health Standards

A public health system guided by a collective vision was identified as a key action in the seminal 2006 report which prompted the public health renewal process in Nova Scotia, The Renewal of Public Health in Nova Scotia: Building a Public Health System to Meet the Needs of Nova Scotians. This report emphasized the necessity for a set of public health standards that establish the expectations for public health at the provincial and regional system levels (N.S. – Health and Wellness, 2011).

The Nova Scotia Public Health Standards comprise four areas of focus: healthy development, healthy communities, communicable disease prevention and control, and environmental health. In addition, a separate foundational standard addresses key elements upon which the four focus-area standards are based: understanding (including population health assessment and health surveillance); health equity and social justice; public health workforce development; public health emergency management; and public health system infrastructure development (N.S. – Health and Wellness, 2011).

It is anticipated that these standards will be updated on a periodic basis (N.S. – Health and Wellness, 2011).

REGIONAL LEVEL

On April 1, 2015, all nine district health authorities were amalgamated into the Nova Scotia Health Authority (N.S. – Health and Wellness, 2018c).

Public health is now organized across four geographic management areas within the Nova Scotia Health Authority (N.S. – Health and Wellness, 2018c).

CHIEF MEDICAL OFFICER OF HEALTH

The current Chief Medical Officer of Health is Dr. Robert Strang (N.S. – Health and Wellness, 2017b).

The Chief Medical Officer of Health (CMOH) fulfills various public health management functions. In accordance with the Health Protection Act, the CMOH has the power to direct and monitor local and regional medical officers. Furthermore, during a public health emergency, the Chief Medical Officer of Health may directly implement measures to mitigate said emergency (Fafard, McNena, Suszek, & Hoffman, 2018).

REFORMS

2015 – Creation of Nova Scotia Health Authority

All nine existing district health authorities in Nova Scotia are amalgamated into one provincial health authority called the Nova Scotia Health Authority under proclamation of the Health Authorities Act (Health Authorities Act, 2014; N.S. – Health and Wellness, 2018c).

2012 – Public Health Protocols

A series of public health protocols in relation to the Nova Scotia Public Health Standards are developed (N.S. – Health and Wellness, 2012a).

2012 – Mid-course Review of Renewal of Public Health in Nova Scotia

The renewal of public health began in 2006 with the release of a report entitled Renewal of Public Health in Nova Scotia: Building a Public Health System to Meet the Needs of Nova Scotians listing actions to increase public health capacity across Nova Scotia. In 2012, a mid-course review of this report is published. It addresses the progress made to date with respect to public health system renewal and sets priorities for future system development (N.S. – Health and Wellness, 2012b, 2017b).

2011 – Nova Scotia Public Health Standards

In accordance with the public health renewal process which began in 2006, the Nova Scotia Public Health Standards (2011-2016) are released (N.S. – Health and Wellness, 2011).

2011 – Reorganization of the Department of Health

The Government of Nova Scotia abolishes the Department of Health Promotion and Protection (which had a public health mandate and housed the Chief Medical Officer of Health). Its responsibilities are transferred to the Department of Health which is renamed the Department of Health and Wellness (Nova Scotia Archives, 2018).

2005 – Health Protection Act

The Health Protection Act comes into effect, providing a legal framework for dealing with health hazards, notifiable diseases or conditions, communicable diseases, public health emergencies, and food safety. In addition, it clarifies the roles and responsibilities of public health administrators and professionals (N.S. – Health, 2005).

REFERENCES

Fafard, P., McNena, B., Suszek, A., & Hoffman, S. J. (2018). Contested roles of Canada’s Chief Medical Officers of Health. Canadian Journal of Public Health. doi:10.17269/s41997-018-0080-3

Health Authorities Act, S.N.S. 2014, c.32. Retrieved from: http://nslegislature.ca/legc/bills/62nd_2nd/3rd_read/b001.htm

Nova Scotia Archives. (2018). Government Administrative Histories Online. Nova Scotia. Department of Health Promotion and Protection. Consulted on October 25, 2018: https://novascotia.ca/archives/gaho/authority.asp?ID=40

Nova Scotia Health Authority. (2017). About Us. Consulted on October 25, 2018: http://www.nshealth.ca/about-us

N.S. – Health. (2005). A Guide to the Health Protection Act and Regulations. Retrieved from https://novascotia.ca/dhw/cdpc/documents/Guide-to-the-Health-Protection-Act-and-Regulations.pdf

N.S. – Health and Wellness. (2011). Nova Scotia Public Health Standards 2011-2016. Retrieved from: https://novascotia.ca/dhw/publichealth/documents/Public_Health_Standards_EN.pdf

N.S. – Health and Wellness. (2012a) The Path of Public Health’s Future. Retrieved from: https://novascotia.ca/dhw/publichealth/documents/Public_Health_Future.pdf

N.S. – Health and Wellness. (2012b). The Renewal of Public Health in Nova Scotia: Building a Public Health System to Meet the Needs of Nova Scotians. Mid Course Review – 2011. Retrieved from: https://novascotia.ca/dhw/publichealth/documents/Renewal-of-Public-Health-Mid-Course-Review.pdf

N.S. – Health and Wellness. (2017a). Statement of Mandate 2015-2016. Retrieved from: https://novascotia.ca/dhw/corporate-reports/documents/DHW_Statement_of_Mandate_for_2015-2016.pdf

N.S. – Health and Wellness. (2017b). Public Health. Chief Medical Officer of Health Dr. Robert Strang. Consulted on October 25, 2018: https://novascotia.ca/dhw/publichealth/cpho.asp

N.S. – Health and Wellness. (2018a). Public Health. Consulted on October 25, 2018: https://novascotia.ca/dhw/publichealth/

N.S. – Health and Wellness. (2018b). Environmental Health. Consulted on October 25, 2018: https://novascotia.ca/dhw/environmental/

N.S. – Health and Wellness. (2018c) Nova Scotia Health Authority. Consulted on October 25, 2018: http://novascotia.ca/dhw/about/nova-scotia-health-authority.asp

Nunavut

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

NUNAVUT

TERRITORIAL LEVEL

Department of Health

“The Department of Health is responsible for health services and social programming in Nunavut” (Nun. – Department of Health, n.d.-a).

Within the Department of Health, “The Public Health Branch provides direction and leadership throughout Nunavut regarding the core functions of public health, which include population health assessment, health surveillance, health promotion, disease and injury prevention, health protection and management of public health emergencies” (Government of Nunavut, 2018, p.140).

The Public Health Branch comprises the Office of the Chief Medical Officer of Health, the Health Protection Unit, the Population Health Program, and the Population Health Information Unit (Government of Nunavut, 2018, p.141).

Other branches with a broad population health portfolio include the Quality of Life Secretariat and the Health Care Service Delivery Branch.

“The Quality of Life Secretariat provides strategic planning, leadership and coordination for the Government of Nunavut’s suicide prevention initiatives, plans and strategies. The Secretariat reports to the Minister responsible for Suicide Prevention and the Cabinet Committee on Quality of Life” (Government of Nunavut, 2018, p. 138).

“The Health Care Service Delivery Branch includes clinical services provided at community and regional health centers, and the Qikiqtani General Hospital. The Branch provides mental health, long-term care and home and community support services” (Government of Nunavut, 2018, p.143-144).

Other governmental departments where broader population health and intersectoral action may be considered include Family Services, Community and Government Services, Environment, Education, and Culture and Heritage (Personal communication, October 10, 2018).

REGIONAL LEVEL

There are no regional health authorities in Nunavut. The Department of Health manages the delivery of services through three regional offices covering the three administrative regions: Kitikmeot Region, Kivalliq Region, and Baffin Region (Bergevin, et al., 2016; Nun. – Department of Health, n.d.-b).

Each of Nunavut’s 25 remote communities is served by a community health centre. Community health programs within these centres include, but are not limited to, well woman and man clinics, immunizations, school health, mental health, and chronic disease clinics (Personal communication, October 15, 2018). In addition, Community Health Representatives and Community Health Development Coordinators located at community health centres within each community work in community health promotion (Nun. – Department of Health and Social Services, 2010, p. 21; Personal communication, October 15, 2018).

Furthermore, health and well-being at the community level is the responsibility of Health Committees, unique to each community in Nunavut. Health Committees have a broad mandate to work on health promotion and community involvement, as well as providing support for health and well-being programs (Nun. – Department of Health and Social Services, 2010, pp. 25, 29; Personal communication, October 15, 2018).

CHIEF MEDICAL OFFICER OF HEALTH

Dr. Mike Patterson is the acting Chief Medical Officer of Health for Nunavut until the position is permanently filled (Nunatsiaq News, 2018).

The “Chief Medical Officer of Health (CMOH) provides leadership and expertise to population health and health protection programs. The CMOH also establishes and maintains public health standards and best practices as well as advocating for the preservation and improvement of the health of Nunavummiut [the people of Nunavut]” (Government of Nunavut, 2018, p.141).

The Public Health Act frames the powers and duties of this office, though specific responsibilities are not outlined (Personal communication, October 10, 2018).

REFORMS

2016 – Public Health Act

A new Public Health Act is introduced, providing a legal framework for taking public health measures, including measures relating to health promotion, health protection, population health assessment, public health surveillance, disease and injury prevention, and public health emergency preparedness and response (Public Health Act, 2016).

2013 – Restructuring the Department of Health and Social Services

The Department of Health and Social Services is split into two stand-alone departments: the Department of Health and the Department of Family Services (Nunatsiaq News, 2012).

REFERENCES

Bergevin, Y., Habib, B., Elicksen, K., Samis S., Rochon, J., Adaimé, C., … Roy, D. (2016). Towards the Triple Aim of Better Health, Better Care and Better Value for Canadians: transforming regions into high performing health systems. Ottawa: Canadian Foundation for Healthcare Improvement. Retrieved from: https://www.cahspr.ca/web/uploads/conference/2016-03-31_Regionalization_Report.pdf

Government of Nunavut. (2018). Business Plan 2018-2021. Retrieved from: https://www.gov.nu.ca/sites/default/files/2018-2021_business_plan-eng.pdf

Nun. – Department of Health. (n.d.-a). About us. Welcome to Health. Consulted on October 11, 2018: https://www.gov.nu.ca/health/information/about-us

Nun. – Department of Health. (n.d.-b). Contact Us. Key People. Consulted on October 11, 2018: https://www.gov.nu.ca/health/information/contact-us-0

Nun. – Department of Health and Social Services. (2010). Community Voices: A Report from the Regional Community Health and Wellness Meetings. Retrieved from: https://www.gov.nu.ca/sites/default/files/files/Final%20Community%20Voices%20Report%20English%20pdf.pdf

Nunatsiaq News. (2012, July 11). Nunavut government starts major retrofit. News Article. Retrieved from: http://www.nunatsiaqonline.ca/stories/article/65674nunavut_government_starts_major_retrofit/

Nunatsiaq News. (2018, October 19). Nunavut’s chief medical officer abruptly vacates her job. News Article. Retrieved from: http://nunatsiaq.com/stories/article/65674nunavuts_chief_medical_officer_vacates_role/

Public Health Act, 2016, Chapter 13. Retrieved from: https://www.nunavutlegislation.ca/iu/download/file/fid/11166

Ontario

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

ONTARIO

PROVINCIAL LEVEL

Ministry of Health and Long-Term Care

The mandate of the Ministry of Health and Long-Term Care comprises:

“Establish[ing] the strategic direction and provincial priorities for the health care system.
Develop[ing] legislation, regulations, standards, policies and directives to support strategic directions.
Monitor[ing] and report[ing] on the performance of the health care system and the health of Ontarians.
Plan[ing] for and establish[ing] funding models and funding levels for the health care system.
Manag[ing] key provincial programs, including the Ontario Health Insurance Program, Assistive Devices Program, drug programs, independent health facilities and laboratory services” (Ont. – Ministry of Health and Long-Term Care, 2017a).

Within the ministry, under the direction of the Associate Deputy Minister – Policy and Transformation, the Population and Public Health Division is responsible for “developing provincial public health initiatives and strategies, and funding and monitoring public health programs delivered by public health units. It also works to ensure that appropriate actions are taken to respond to urgent and emergency situations” (Office of the Auditor General of Ontario, 2017b, p. 532; see also Ont. – Ministry of Health and Long-Term Care, 2018a).

Its roles and responsibilities include:

“Conduct[ing] surveillance for ongoing assessment of public health risks;
Implement[ing] strategies to ensure continuity of critical ministry services during an emergency;
Ensur[ing] appropriate actions are taken to respond to urgent and/or emergency situations;
Anticipat[ing], prevent[ing] and respond[ing] to health risks and hazards by designing, implementing, funding and monitoring public health programs;
Striv[ing] to ensure provincial compliance with national and international obligations;
Engag[ing] with local, national and international partners in order to shape public health strategies;
Inform[ing] and advis[ing] other provincial partners on evidence-based human health impacts of government initiatives;
Advanc[ing] public health in Ontario by providing and supporting education, research, training, and resource tools; and
Develop[ing] the public health sector strategic direction within the broader health [system].” (Government of Ontario, n.d.).

The Population and Public Health Division is composed of six branches: Strategy and Planning, Health System Emergency Management, Accountability and Liaison, Health Protection and Surveillance Policy and Programs, Health Promotion and Prevention Policy and Programs, and Health Improvement Policy and Programs (Ont. – Ministry of Health and Long-Term Care, 2018a).

An organizational chart of the Ministry of Health and Long-Term Care is available below.

Ministry of Children, Community and Social Services

The Ministry of Children, Community and Social Services has the following mandate:

“make it easier for families to find the services to give kids the best start in life,
make it easier for families to access the services they need at all stages of a child’s development,
and help youth become productive adults.” (Ont. – Ministry of Children, Community and Social Services, 2016).

This ministry’s work intersects with public health functions in numerous areas, including perinatal health, child and youth mental health, policies for children with special needs, Indigenous children and youth strategies, and nutrition in schools. The ministry mandate related to public health functions is set out in the Health Protection and Promotion Act (Personal communication, October 5, 2018).

In addition, elements of the Ontario Public Health Standards are implemented by the Ministry of Children, Community and Social Services in collaboration with public health units as per the above areas (Personal communication, October 5, 2018).

Ministry of Education

The mandate of the Ministry of Education comprises four goals: achieving academic excellence; ensuring equity for all students; promoting well-being, including enhanced mental and physical health, a positive sense of self and belonging and skills to make positive choices; and enhancing public confidence in a publicly funded education system (Ont. – Ministry of Education, 2017).

As part of the Ontario Public Health Standards and the School Health Guideline, 2018, each of the public health units work with the boards of education within their respective boundaries to implement health-related curricula related to: injury prevention, healthy eating, healthy sexuality, immunization, infectious disease prevention, suicide prevention, physical activity promotion, mental health promotion, substance use and harm reduction, etc. (Ont. – Ministry of Health and Long-Term Care, 2018b).

The legislative framework for public health functions in the education sector is the Health Protection and Promotion Act and the Immunization of School Pupils Act (Personal communication, October 5, 2018).

Public Health Ontario

Created by legislation in 2007, Public Health Ontario (PHO) is an operational service agency of the provincial government. “Public Health Ontario provides expert scientific and technical advice and support to government, local public health units and health care providers” (Public Health Ontario, 2013, p.4) to “enable informed decisions and actions that protect and promote health and contribute to reducing health inequities” (Public Health Ontario, 2016). As such, “PHO works closely with the Chief Medical Officer of Health, the Ministry of Health and Long-Term Care and local public health units” (Public Health Ontario, 2013, p.4).

Public Health Ontario’s areas of expertise include chronic disease prevention, environmental health, infectious disease, microbiology, emergency preparedness, health promotion, injury prevention and occupational health (Public Health Ontario, 2013, p.4).

Ontario Public Health Standards

“The Ontario Public Health Standards: Requirements for Programs, Services, and Accountability (Standards) identify the minimum expectations for public health programs and services to be delivered by Ontario’s … boards of health. The Standards are published by the Minister of Health and Long-Term Care as per Section 7 of the Health Protection and Promotion Act. Boards of health are accountable for implementing the Standards including the protocols and guidelines that are referenced therein” (Ont. – Ministry of Health and Long-Term Care, 2018c). These protocols and guidelines provide direction on how boards of health must operationalize and implement requirements identified in the Standards (Ont. – Ministry of Health and Long-Term Care, 2018c). Reference documents also exist to assist professional staff in the implementation of standards, protocols and guidelines (Ont. – Ministry of Health and Long-Term Care, 2018d).

Click here to consult the Ontario Public Health Standards.

REGIONAL LEVEL

Public Health Units

At the regional level, public health is administered by 34 public health units (Personal communication, October 15, 2018). “A Public Health Unit is an official health agency established by a group of urban and rural municipalities to provide a more efficient community health program” (Ont. – Ministry of Health and Long-Term Care, 2018e). Each public health unit is administered by a medical officer of health who reports to a local governing board of health, an autonomous corporation under the Health Protection and Promotion Act (Ont. – Ministry of Health and Long-Term Care, 2018e).

According to the Health Protection and Promotion Act, public health units must provide programming in the following areas:

“Community sanitation and the prevention or elimination of health hazards;
Provision of safe drinking water by small drinking water systems;
Control of infectious [sic] and diseases of public health significance, including providing immunization services to children and adults;
Health promotion, health protection, and disease and injury prevention;
Family health;
Collection and analysis of epidemiological data; and
Such additional health programs and services as prescribed by regulations” (Ont. – Ministry of Health and Long-Term Care, 2018f, p.8).

Local Health Integration Networks (LHINs)

Established in 2006 through the Local Health System Integration Act, LHINs are “not-for-profit corporations responsible for planning, delivering and funding local health care to 14 different geographic areas of the province” (Ont. – Ministry of Health and Long-Term Care, 2017b).

They are distinct from regional health authorities, but are responsible for providing health services, including “primary care, home and community care, community health centres, hospitals, long-term care and mental health and addiction services” (Ont. – Ministry of Health and Long-Term Care, 2017b).

Under the Patients First Act, 2016, the Local Health System Integration Act, 2006 was amended to include home and community care and primary care planning functions under a LHIN (Office of the Auditor General of Ontario, 2017b, p. 110; Patients First Act, 2016, Part V.1). Accordingly, “All LHINs are now also required to participate in the development and implementation of health-promotion strategies in co-operation with primary health-care services, public health services and community-based services” (Office of the Auditor General of Ontario, 2017b, p. 110-111).

CHIEF MEDICAL OFFICER OF HEALTH

Dr. David Williams is Ontario’s Chief Medical Officer of Health, effective February 2016 (Ont. – Ministry of Health and Long-Term Care, 2016).

The Chief Medical Officer of Health works within the Ministry of Health and Long Term Care and reports directly to the Deputy Minister of Health and Long-Term Care (Ont. – Ministry of Health and Long-Term Care, 2018a).

“The Chief Medical Officer’s responsibilities include the following:

Provides clinical and public-health practice leadership and advice to the public-health sector;
Identifies and assesses risk and opportunities for improvement in public health in Ontario;
Communicates directly with the public with respect to public health, such as on the risk of the Zika virus to Ontarians; and
Reports annually to the Legislature on the provincial state of public health” (Office of the Auditor General of Ontario, 2017a, p. 532).

REFORMS

2018 – Revision of Ontario Public Health Standards

The revised Ontario Public Health Standards and Protocols are implemented (Ont. – Ministry of Health and Long-Term Care, 2018e).

2018 – Amendments to Regulations made under the Health Protection and Promotion Act

Amendments to regulations under the Health Protection and Promotion Act include, but are not limited to, improving food safety, ensuring public health and safety at recreational camps, pools and spas, enhancing prevention measures for infectious diseases, as well as changes to reflect present practices and delivery of public health services (Health Protection and Promotion Act, 1990).

2011 – Merger with the Ministry of Health and Long-Term Care

The Ministry of Health Promotion and Sport is merged with the Ministry of Health and Long-Term Care (Office of the Auditor General of Ontario, 2012).

2011 – Public Health Ontario

The Ontario Agency for Health Protection and Promotion announces that it will operate under the new name of Public Health Ontario (Public Health Ontario, 2011).

2009 – Ontario Public Health Standards

The Ontario Public Health Standards and Protocols are published by the Minister of Health and Long-Term Care as per the Health Protection and Promotion Act (Section 7). These replace the Mandatory Health Programs and Services Guidelines of 1997 (Personal communication, October 15, 2018).

2008 – Ontario Agency for Health Protection and Promotion

The Ontario Agency for Health Protection and Promotion (now known as Public Health Ontario) is created as an operational service agency of the Ministry of Health and Long-Term Care with a mandate to provide scientific and technical advice and support to the healthcare system. The Agency will be a centre for specialized research and knowledge in public health, focusing on the areas of infectious disease, infection control and prevention, health promotion, chronic disease and injury prevention and environmental health (Ontario Agency for Health Protection and Promotion Act, 2007; Public Health Ontario, 2013, p.3).

REFERENCES

Government of Ontario. (n.d.). Government of Ontario Employee and Organization Directory. INFO-GO. Consulted on October 12, 2018: http://www.infogo.gov.on.ca/infogo/#orgProfile/3607/en

Health Protection and Promotion Act, R.S.O. 1990, c. H.7. Retrieved from https://www.ontario.ca/laws/statute/90h07

Office of the Auditor General of Ontario. (2012). Annual Report. Ministry of Health and Long-Term Care. Diabetes Management. Chapter 3, Section 3.03. Retrieved from: http://www.auditor.on.ca/en/content/annualreports/arreports/en12/303en12.pdf

Office of the Auditor General of Ontario. (2017a). Annual Report. Ministry of Health and Long-Term Care. Public Health: Chronic Disease Prevention. Chapter 3, Section 3.10. Retrieved from: http://www.auditor.on.ca/en/content/annualreports/arreports/en17/v1_310en17.pdf

Office of the Auditor General of Ontario. (2017b). Annual Report. Ministry of Health and Long-Term Care. LHINs—Local Health Integration Networks. Chapter 1, Section 1.08. Retrieved from: http://www.auditor.on.ca/en/content/annualreports/arreports/en17/v2_108en17.pdf

Ontario Agency for Health Protection and Promotion Act, 2007, S.O. 2007, c. 10, Sched. K. Retrieved from: https://www.ontario.ca/laws/statute/07o10?search=Ontario+Agency+for+Health+Protection+and+Promotion+Act

Ont. – Ministry of Children, Community and Social Services. (2016). Ministry of Children and Youth Services. Consulted on October 12, 2018: http://www.children.gov.on.ca/htdocs/English/about/index.aspx

Ont. – Ministry of Education. (2017). About the Ministry. Consulted on October 12, 2018: http://www.edu.gov.on.ca/eng/about/excellent.html

Ont. – Ministry of Health and Long-Term Care. (2016). About the Ministry. Chief Medical Officer of Health. Consulted on October 12, 2018: http://www.health.gov.on.ca/en/common/ministry/cmoh.aspx

Ont. – Ministry of Health and Long-Term Care. (2017a). Ministry Plans. Consulted on October 12, 2018: http://www.health.gov.on.ca/en/common/ministry/publications/plans/ppar17/

Ont. – Ministry of Health and Long-Term Care. (2017b). Health Services in Your Community. Consulted on October 12, 2018: http://www.health.gov.on.ca/en/common/system/services/default.aspx

Ont. – Ministry of Health and Long-Term Care. (2018a). Organizational Structure of the Ministry of Health and Long-Term Care. Consulted on October 12, 2018: http://www.health.gov.on.ca/en/common/ministry/orgchart10182018.pdf

Ministry of Health and Long-Term Care. (2018b). School Health Guideline, 2018. Retrieved from: http://www.ontariohealthyschools.com/uploads/2/1/7/6/21766954/ontario_school_health_guideline_2018.pdf

Ont. – Ministry of Health and Long-Term Care. (2018c). Ontario Public Health Standards. Consulted on October 12, 2018: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/

Ont. – Ministry of Health and Long-Term Care. (2018d). Ontario Public Health Standards: Reference Documents. Consulted on October 12, 2018: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/reference.aspx

Ont. – Ministry of Health and Long-Term Care. (2018e). Health Services in Your Community. Public Health Units. Consulted on October 12, 2018: www.health.gov.on.ca/en/common/system/services/phu/

Ont. – Ministry of Health and Long-Term Care. (2018f). Ontario Public Health Standards: Requirements for Programs, Services, and Accountability. Retrieved from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Ontario_Public_Health_Standards_2018_en.pdf

Patients First Act, 2016, S.O. 2016, c. 30 – Bill 41. Retrieved from https://www.ontario.ca/laws/statute/S16030

Public Health Ontario. (2011, July 13). Public Health Ontario is the new operating name for the Ontario Agency for Health Protection and Promotion. News Release. Retrieved from: http://www.publichealthontario.ca/en/About/Newsroom/Pages/Public-Health-Ontario-is-the-new-operating-name-for-the-Ontario-Agency-for-Health-Protection-and-Promotion.aspx

Public Health Ontario. (2013). Public Health Ontario Strategic Plan 2014 – 2019: Evidence, knowledge and action for a healthier Ontario. Retrieved from: http://www.publichealthontario.ca/en/eRepository/StrategicPlan_Interactive_2014_2019.pdf

Public Health Ontario. (2016). About us. Vision, Mission, Mandate and Values. Consulted on October 12, 2018: http://www.publichealthontario.ca/en/About/Pages/Mission-Vision-and-Values.aspx

Prince Edward Island

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

PRINCE EDWARD ISLAND

PROVINCIAL LEVEL

Department of Health and Wellness

“The Department of Health and Wellness provides oversight to health services in the province in accordance with the Health Services Act. It establishes an accountability framework, standards for health services, performance targets, policy or guidelines for the management of operations and delivery of services and approves business plans and budgets.

The Department also provides leadership in all matters related to public health and health promotion and informs policy to improve the health and well-being of citizens” (P.E.I. – Department of Health and Wellness, 2018).

Within the Department of Health and Wellness, the Chief Public Health Office is responsible for P.E.I.’s public health functions. The Department of Health and Wellness also comprises the Health Policy and Programs Division, responsible for health-related policy development and planning, and the Sport, Recreation and Physical Activity Division, responsible for promoting active living (P.E.I. – Department of Health and Wellness, 2018).

Health PEI

Health PEI is responsible for the delivery of publicly funded health services in Prince Edward Island. This includes the operation of hospitals, health centers, and long-term care facilities, as well as public health programming, home care services, primary care networks, mental health and addiction services, and community-based programs and services (Health P.E.I., 2017, p. 2; Health P.E.I, 2018).

According to the Health Services Act, “Health PEI shall

a) provide, or provide for the delivery of, health services in accordance with the provincial health plan;
b) operate and manage health facilities in accordance with the provincial health plan;
c) manage the financial, personnel and other resources necessary to provide the health services and operate the health facilities required by the provincial health plan; and
d) perform such other functions as the Minister may direct” (Health Services Act, 2010).

Health PEI’s organizational structure can be visualized below.

REGIONAL LEVEL

Prior to April 2005, health and social services were administered by four regional health authorities (P.E.I. – Ministry of Health, 2006, p.3). Responsibility was transferred to the Department of Health (subsequently renamed the Department of Health and Wellness) when the regional health authorities were abolished (The Institute of Public Administration of Canada, 2013).

The Health Services Act came into effect April 10, 2010, creating a single health authority, Health P.E.I. (P.E.I. – Department of Health and Wellness, 2011, p. 1). Health PEI is now responsible for the delivery of public health programs (Health P.E.I., 2017, p. 2; Health P.E.I, 2018).

CHIEF PUBLIC HEALTH OFFICER

The current Chief Public Health Officer is Dr. Heather G. Morrison (P.E.I. – Department of Health and Wellness, 2018).

The Chief Public Health Office (CPHO) is a division of the Department of Health and Wellness. The Office works “with the health system, other government departments and communities to prevent disease and injury and deliver health protection programs under [the] Public Health Act and Regulations of Prince Edward Island” (P.E.I. – Department of Health and Wellness, 2018). Its functions include population health assessment, surveillance, health promotion, disease prevention, and health protection (P.E.I. – Department of Health and Wellness, 2018). Under the Public Health Act, the Chief Public Health Officer also holds an advisory role vis-à-vis the Minister of Health and Wellness, limited to specific situations, such as emergencies (Fafard, McNena, Suszek & Hoffman, 2018).

The CPHO comprises the following sections: Communicable Disease Program, Environmental Health, Health Promotion, and Population Health and Surveillance (P.E.I. – Department of Health and Wellness, 2018).

REFORMS

2013 – Prince Edward Island Public Health Act

The Prince Edward Island Public Health Act is proclaimed. Changes brought about by this Act are meant to help better address modern public health issues and support the Chief Public Health Officer in monitoring and maintaining public health. Specifically, this legislation helps to ensure public health officials are able to identify, respond to and report on communicable diseases, that food premises are licensed and serving safe food, that milk processing meets current standards, and that public health officials are properly investigating health hazards (P.E.I. – Department of Health and Wellness, n.d, p. 2).

2010 – Health Services Act

The Health Services Act comes into effect, creating a single health authority, Health P.E.I. (P.E.I. – Department of Health and Wellness, 2011, p. 1).

REFERENCES

Fafard, P., McNena, B., Suszek, A. & Hoffman, S. J. (2018). Contested roles of Canada’s Chief Medical Officers of Health. Canadian Journal of Public Health. doi:10.17269/s41997-018-0080-3

Health P.E.I. (2017). Annual Report 2016-2017. Retrieved from http://www.assembly.pe.ca/docs/2016-17-healthPEI-ar.pdf

Health P.E.I. (2018). About us. Consulted on November 12, 2018: https://www.princeedwardisland.ca/en/topic/health-pei

Health Services Act, 2010, Chapter H-1.6. Retrieved from: https://www.princeedwardisland.ca/sites/default/files/legislation/h-01-6-health_services_act.pdf

The Institute of Public Administration of Canada. (2013). Healthcare Governance Models in Canada: A Provincial Perspective: HealthcareGovernance Pre-summit Discussion Paper. Toronto: The Institute of Public Administration of Canada. Retrieved from: http://neltoolkit.rnao.ca/sites/default/files/Healthcare%20Governance%20Models%20in%20Canada_A%20Provincial%20Perspective_Pre-Summit%20Disscussion%20Paper%20March%202013.pdf

P.E.I. – Department of Health and Wellness. (n.d.). Annual Report 2014-2015. Retrieved from https://www.princeedwardisland.ca/sites/default/files/publications/dhw_annual_report_14-15.pdf

P.E.I. – Department of Health and Wellness. (2011). Annual report 2010-2011. Retrieved from: https://www.princeedwardisland.ca/sites/default/files/publications/ar_healthwell-2010-2011.pdf

P.E.I. – Department of Health and Wellness. (2018). About: Health and Wellness. Consulted on November 12, 2018: https://www.princeedwardisland.ca/en/department/health-and-wellness/about

P.E.I. – Ministry of Health. (2006). Annual report 2005-2006. Retrieved from: http://www.gov.pe.ca/publications/getpublication.php3?number=1359

Saskatchewan

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

SASKATCHEWAN

PROVINCIAL LEVEL

Ministry of Health

“Through leadership and partnership, the Ministry of Health is dedicated to achieving a responsive, integrated and efficient health system that puts the patient first, and enables people to achieve their best possible health by promoting healthy choices and responsible self-care” (Sask. – Ministry of Health, 2017, p.6).

Within the Ministry of Health, public health is chiefly the responsibility of the Primary Health Services Branch, the Community Care Branch, the Population Health Branch, and the Saskatchewan Disease Control Lab (Sask. – Ministry of Health, 2017, p.45).

The Population Health Branch comprises the Office of the Chief Medical Health Officer, as well as the following units: Disease Prevention, Environmental Health, Surveillance and Central Support and Tobacco Litigation (Saskatchewan Government Telephone Directory, 2018a).

Saskatchewan Health Authority

“On December 4, 2017, the Saskatchewan Health Authority launched, transitioning 12 former Regional Health Authorities to a single provincial health authority” (Saskatchewan Health Authority, 2018a).

“The move to a single provincial health authority is being driven by the commitment to improve frontline patient care for Saskatchewan people. One provincial health authority that is focused on better coordination of health services across the province will ensure patients receive high quality, timely health care, regardless of where they live in Saskatchewan” (Government of Saskatchewan, n.d.).

“The Saskatchewan Health Authority is governed by the Saskatchewan Health Authority Board of Directors. The Board is composed of 10 members, all appointed for three-year terms by the Minister of Health” (Saskatchewan Health Authority, 2018b).

Consult the organizational chart of the Saskatchewan Health Authority below.

REGIONAL LEVEL

In 2017, the existing 12 regional health authorities were merged into a single provincial health authority (Saskatchewan Health Authority, 2018a).

CHIEF MEDICAL HEALTH OFFICER

Dr. Saqib Shahab is the Chief Medical Health Officer for the Saskatchewan Ministry of Health. The Office of the Chief Medical Health Officer is located within the Population Health Branch of the Ministry of Health (Saskatchewan Government Telephone Directory, 2018b).

REFORMS

2017 – Provincial Health Authority Act

The Regional Health Services Act is abolished with the proclamation of the Provincial Health Authority Act. The existing 12 regional health authorities are amalgamated into a single provincial health authority (Government of Saskatchewan, 2017a, 2017b).

1994 – Public Health Act

This Act allows the Lieutenant Governor in Council to make regulations concerning public health issues including air and water pollution, food safety, and the prevention, detection, investigation, treatment or control of non-communicable and communicable diseases. It also governs the issuance of vaccines and immunization service delivery (Public Health Act, 1994).

REFERENCES

Government of Saskatchewan. (n.d.). Transitioning to a Single Provincial Health Authority. Retrieved from: https://www.saskatchewan.ca/residents/health/health-system-transformation/transitioning-to-a-single-provincial-health-authority

Government of Saskatchewan. (2017a, March 28). Legislation Introduced to Create Provincial Health Authority. News Release. Retrieved from: https://www.saskatchewan.ca/government/news-and-media/2017/march/28/health-authority-act

Government of Saskatchewan. (2017b, December 4). Legislation Proclaimed to Launch Saskatchewan Health Authority. News Release. Retrieved from: http://www.saskatchewan.ca/government/news-and-media/2017/december/04/launch-of-sha

Northern Inter-Tribal Health Authority. (n.d.-a). Consulted on October 22, 2018: http://www.nitha.com/

Northern Inter-Tribal Health Authority. (n.d.-b). Public Health Unit. Consulted on October 22, 2018: http://www.nitha.com/public-health-unit/

Public Health Act, 1994, SS 1994, c P-37.1. Retrieved from: http://www.publications.gov.sk.ca/freelaw/documents/English/Statutes/Statutes/P37-1.pdf

Saskatchewan Government Telephone Directory. (2018a). Population Health Branch. Consulted on October 22, 2018: http://gtds.gov.sk.ca/Pages/Details.aspx?organizationid=59e58710-1dcf-4a57-bd94-6281ad5d4aa2

Saskatchewan Government Telephone Directory. (2018b). Office of the Chief Medical Health Officer. Consulted on October 22, 2018: http://gtds.gov.sk.ca/Pages/Details.aspx?organizationid=43561b37-28f1-4251-8054-53bff17f24a8

Saskatchewan Health Authority. (2018a). Our Organization. Consulted on October 22, 2018: https://www.saskhealthauthority.ca/about/Pages/default.aspx

Saskatchewan Health Authority. (2018b). Governance. Consulted on October 22, 2018: https://www.saskhealthauthority.ca/about/Pages/Governance.aspx

Sask. – Ministry of Health. (2017). Ministry of Health Annual Report 2016-2017. Regina: Government of Saskatchewan. Retrieved from: http://publications.gov.sk.ca/documents/15/104262-2016-17HealthAnnualReport.pdf

Yukon

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

YUKON TERRITORY

TERRITORIAL LEVEL

Department of Health and Social Services

The mission of the Department of Health and Social Services comprises “promot[ing], protect[ing], and enhanc[ing] the well-being of Yukon people through a continuum of quality, accessible, and appropriate health and social services” (Y.T. – Department of Health and Social Services, 2017a).

Within the Department of Health and Social Services, the Health Services Division provides health and medical services and operates health facilities (Y.T. – Department of Health and Social Services, 2017b).

Within the Health Services Division, the Office of the Chief Medical Officer of Health (CMOH), Community Health Programs, and Community Nursing are responsible for public health services (Y.T. – Department of Health and Social Services, 2017b; Personal communication, October 9, 2018). Programs delivered by Community Health Programs include the Yukon Communicable Disease Control Program, the Yukon Children’s Dental Program, Environmental Health Services, Mental Health Services and Health Promotion (Y.T. – Department of Health and Social Services, 2017c). Community Nursing provides Primary Health Care (Y.T. – Department of Health and Social Services, 2017b).

Within the Social Services Division of the Department of Health and Social Services, Adult Services, Community and Program Support, Family and Children’s Services, Mental Wellness and Substance Use Services, and Services for People with Disabilities also deliver prevention, education and awareness services (Y.T. – Department of Health and Social Services, 2017d; Personal communication, October 9, 2018).

See the following Yukon Department of Health and Social Services’ organizational charts, below.

REGIONAL LEVEL

There is no regional health authority in Yukon (Bergevin et al., 2016, p. 8). Three hospitals and fourteen community health centres are situated across the territory (Y.T. – Department of Health and Social Services, 2017e, 2017f).

Community health centres are “staffed by one or more nurses and auxiliary staff. Primary Health Care Nurses in the absence of a physician, provide daily clinics for medical treatment, community health programs and 24-hour emergency services” (Y.T. – Department of Health and Social Services, 2017e). Community health programs offered through community health centres include, but are not limited to, maternal-child health, school health, immunization, health education/promotion, chronic disease follow-up and communicable disease testing (Y.T. – Department of Health and Social Services, 2017e; Personal communication, October 9, 2018).

CHIEF MEDICAL OFFICER OF HEALTH

Yukon’s Chief Medical Officer of Health is Dr. Brendan Hanley (Yukon CMOH, 2013a).

“The office of the Yukon Chief Medical Officer of Health is responsible for the Department of Health and Social Services’ legislated responsibility to protect and promote the public’s health in a variety of areas” (Yukon CMOH, 2013b).

According to the Act to amend the Public Health and Safety Act, the “duties and functions of the chief medical officer of health are to:

(a) prevent disease, including monitoring, investigating and responding to a suspected or confirmed communicable disease;
(b) promote health, including alleviating the effects of a communicable disease;
(c) prevent transmission of a communicable disease, including decreasing or eliminating risks associated with a communicable disease;
(d) undertake public health surveillance; and
(e) perform such other duties and functions as are assigned to the chief medical officer of health by an enactment or by the Minister (Act to amend the Public Health and Safety Act, 2009, Section 2.2).

The Chief Medical Officer of Health works in collaboration with Yukon Communicable Disease Control, Environmental Health Services and the Health Promotion Unit, within Community Health Programs, as well as with other ministerial units on health promotion, prevention and surveillance (Yukon CMOH, 2013b).

REFORMS

2014 – Animal Health Act

The Animal Health Act comes into effect on January 1, 2014. The Act addresses hazards and risks to human health, the role and authority of the Chief Veterinary Officer and inspectors, as well as tools for managing hazards. This Act also specifies notification to the Chief Medical Officer of Health if the Chief Veterinary Officer believes that a significant risk to human health exists due to an animal, animal product, conveyance or area (Animal Health Act, 2013).

2009 – Act to Amend Public Health and Safety Act

The Act to Amend Public Health and Safety Act is passed. The Act specifies the roles and responsibilities of the Chief Medical Officer of Health (CMOH) and details the powers of the Minister and the CMOH in the event of a health or public health emergency (Act to amend the Public Health and Safety Act, 2009).

2002 – Health Act

The Health Act is passed, thereby establishing the Department of Health and Social Services. It details the establishment, organization, administration, and funding for health and social service programming. The Act specifically addresses the proportion of the health budget to be appropriated for health promotion and preventive health (Health Act, 2002).

REFERENCES

Act to amend the Public Health and Safety Act, 2009, chapter 18. Retrieved from: http://www.gov.yk.ca/legislation/acts/puhesa_ata.pdf

Animal Health Act, 2013. Retrieved from: http://www.gov.yk.ca/legislation/acts/anhe_2013_c.pdf

Bergevin, Y., Habib, B., Elicksen, K., Samis S., Rochon, J., Adaimé, C., … Roy, D. (2016). Towards the Triple Aim of Better Health, Better Care and Better Value for Canadians: transforming regions into high performing health systems. Ottawa: Canadian Foundation for Healthcare Improvement. Retrieved from: https://www.cahspr.ca/web/uploads/conference/2016-03-31_Regionalization_Report.pdf

Health Act, 2002. Retrieved from: http://www.gov.yk.ca/legislation/acts/health_c.pdf

Yukon Chief Medical Officer of Health. (2013a). Biography. Consulted on October 11, 2018: http://www.yukoncmoh.ca/biography.php

Yukon Chief Medical Officer of Health. (2013b). About the MOH. Consulted on October 11, 2018: http://www.yukoncmoh.ca/about.php

Y.T. – Department of Health and Social Services. (2017a). Mission. Consulted on October 11, 2018: http://www.hss.gov.yk.ca/mission.php

Y.T. – Department of Health and Social Services. (2017b). Health Services. Consulted on October 11, 2018: http://www.hss.gov.yk.ca/healthservices.php

Y.T. – Department of Health and Social Services. (2017c). Community Health Programs. Consulted on October 11, 2018: http://www.hss.gov.yk.ca/communityhealthprograms.php

Y.T. – Department of Health and Social Services. (2017d). Social Services. Consulted on October 11, 2018: http://www.hss.gov.yk.ca/socialservices.php

Y.T. – Department of Health and Social Services. (2017e). Health centres – Communities. Consulted on October 11, 2018: http://www.hss.gov.yk.ca/healthcentres.php

Y.T. – Department of Health and Social Services. (2017f). Hospitals. Consulted on October, 11, 2018: http://www.hss.gov.yk.ca/hospitals.php

Canada

This information has been reviewed and verified by external reviewers and was last updated in November 2018.

Should you discover any errors or omissions, please advise us at ncchpp@inspq.qc.ca.

CANADA

FEDERAL LEVEL

In Canada, the provinces and territories are responsible for providing healthcare services in their jurisdiction. The federal government is responsible for: the administration of, and setting national principles for, the healthcare system through the Canada Health Act; assisting in the financing of provincial/territorial health through fiscal transfers; delivering healthcare services to specific groups (e.g., First Nations and Inuit peoples and veterans) (Health Canada, 2018a).

The federal government also provides, in conjunction with the provinces and territories, other health-related functions such as health research and public health and health protection programs (Health Canada, 2018a).

In addition to the shared public health activities covering the general Canadian population, the areas of intervention and the populations uniquely affected by the activities of one or several agencies or departments of the federal government include:

“First Nations and the Inuit;

active members and veterans of the military;
prisoners in federal penitentiaries;
health requirements for people applying to immigrate to Canada;
occupational health and safety standards for employees in federally regulated industries;
patents for medicines;
environmental research and monitoring;
fitness and amateur sport; and
fitness for duty of air traffic controllers and pilots’’ (Butler & Tiedemann, 2011).

In addition, “Quarantine and the Establishment and Maintenance of Marine Hospitals” falls solely under the federal government authority, as indicated by the Constitution Act of 1867 in section 91.11 (The Constitution Act of 1867).

The various departments and agencies that assume these responsibilities in the federal government are collectively referred to as the health portfolio (Health Canada, 2017).

Minister of Health and the Health Portfolio

“The Minister of Health is responsible for maintaining and improving the health of Canadians. This is supported by the Health Portfolio, which comprises Health Canada, the Public Health Agency of Canada, the Canadian Institutes of Health Research, the Patented Medicine Prices Review Board and the Canadian Food Inspection Agency” (Health Canada, 2017).

Health Canada

“Health Canada is the Federal department responsible for helping Canadians maintain and improve their health, while respecting individual choices and circumstances” (Health Canada, 2014).

Its objectives are to:

“Prevent and reduce risks to individual health and the overall environment;
Promote healthier lifestyles;
Ensure high quality health services that are efficient and accessible;
Integrate renewal of the health care system with longer term plans in the areas of prevention, health promotion and protection;
Reduce health inequalities in Canadian society; and
Provide health information to help Canadians make informed decisions” (Health Canada, 2011).

Health Canada is structured into twelve branches or offices. These are comprised of six central corporate branches and six “thematic” branches. The thematic branches comprise: Healthy Environments and Consumer Safety Branch, Health Products and Food Branch, Strategic Policy Branch, Opioid Response Team, Pest Management Regulatory Agency, and Regulatory Operations and Regions Branch (Health Canada, 2018b).

See the following organizational chart of Health Canada.

Public Health Agency of Canada

“The role of the Public Health Agency of Canada is to:

Promote health;
Prevent and control chronic diseases and injuries;
Prevent and control infectious diseases;
Prepare for and respond to public health emergencies;
Serve as a central point for sharing Canada’s expertise with the rest of the world;
Apply international research and development to Canada’s public health programs; and
Strengthen intergovernmental collaboration on public health and facilitate national approaches to public health policy and planning” (Public Health Agency of Canada, 2017).

The Public Health Agency of Canada is structured in the following manner: under the authority of the Minister of Health, the President and Chief Public Health Officer oversee the activities of four branches and offices: Infectious Diseases Prevention and Control Branch (including the National Microbiology Laboratory); Health Promotion and Chronic Disease Prevention Branch (including the Office of the Chief Dental Officer); Health Security Infrastructure Branch; and Office of Strategic Policy, Planning, and Office of International Affairs Directorate (Public Health Agency of Canada, 2018a).

Canadian Institutes of Health Research

As stated in the constituting act of the Canadian Institutes of Health Research (CIHR): “The objective of the CIHR is to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system” (Canadian Institutes of Health Research, 2010).

“Each Institute includes fundamental bio-medical research, clinical research, and research respecting health systems, health services, the health of populations, societal and cultural dimensions of health and environmental influences on health” (Canadian Institutes of Health Research, 2017).

Thirteen Institutes make up the CIHR:

Institute of Indigenous Peoples’ Health
Institute of Aging
Institute of Cancer Research
Institute of Circulatory and Respiratory Health
Institute of Gender and Health
Institute of Genetics
Institute of Human Development, Child and Youth Health
Institute of Health Services and Policy Research
Institute of Infection and Immunity
Institute of Musculoskeletal Health and Arthritis
Institute of Neurosciences, Mental Health and Addiction
Institute of Nutrition, Metabolism and Diabetes
Institute of Population and Public Health

Patented Medicine Prices Review Board

The Patented Medicine Prices Review Board (PMPRB) is an independent quasi-judicial body with a dual role within the health portfolio (Patented Medicine Prices Review Board, 2018):

“Regulatory – To ensure that prices charged by patentees for patented medicines sold in Canada are not excessive”
“Reporting – To report on pharmaceutical trends of all medicines and on R&D spending by pharmaceutical patentees”

Canadian Food Inspection Agency

“Mitigating risks to food safety is the CFIA’s highest priority, and the health and safety of Canadians is the driving force behind the design and development of CFIA programs. The CFIA, in collaboration and partnership with industry, consumers, and federal, provincial and municipal organizations, continues to work towards protecting Canadians from preventable health risks related to food and zoonotic diseases” (Canadian Food Inspection Agency, 2018a).

Apart from its inspection capacity, CFIA also develops and maintains regulations, policies and programs to safeguard food, animals and plants; promotes compliance; monitors and enforces safety rules; provides regulatory approval in the form of licences, permits and registrations to industry and stakeholders (Canadian Food Inspection Agency, 2018b).

The National Collaborating Centres for Public Health

Other federal institutions carrying out activities related to public health include the National Collaborating Centres for Public Health (NCCs).

Announced in 2004, concordantly with the creation of the Public Health Agency of Canada, the National Collaborating Centres for Public Health were established in 2005 as part of the “federal government’s commitment to renew and strengthen public health across Canada” (Medlar, Mowat, Di Ruggiero & Frank, 2006).

The National Collaborating Centres for Public Health “work together to promote the use of scientific research and other knowledge to strengthen public health practices, programs and policies in Canada” (National Collaborating Centres for Public Health, 2018). Funded by the Public Health Agency of Canada, they have the mandate to reach all public health units across Canada. There are six Centres working on six different themes:

The National Collaborating Centre for Aboriginal Health
The National Collaborating Centre for Determinants of Health
The National Collaborating Centre for Environmental Health
The National Collaborating Centre for Healthy Public Policy
The National Collaborating Centre for Infectious Diseases
The National Collaborating Centre for Methods and Tools

Other pan-Canadian health organizations receiving federal funding include the Canadian Agency for Drugs and Technologies in Health (CADTH), the Canadian Centre on Substance Use and Addiction (CCSA), the Canadian Foundation for Healthcare Improvement (CFHI), the Canada Health Infoway (Infoway), the Canadian Institute for Health Information (CIHI), the Canadian Partnership Against Cancer (CPAC), the Canadian Patient Safety Institute (CPSI), the Mental Health Commission of Canada (MHCC), and the Canadian Public Health Association (CPHA) (Forest & Martin, 2018, p. vii; Personal communication, October 10, 2018).

REGIONAL LEVEL

The federal government does not have a regional governance level. However, the Public Health Agency of Canada and Health Canada are organized regionally.

Public Health Agency of Canada – regional operations

The Public Health Agency of Canada (PHAC) has regional offices in every province and territory, except the Northwest Territories. The Regional Operations Directorate is based in Ottawa (Public Health Agency of Canada, 2018a). The role of the Regional Offices is to administer certain programs, liaise with provincial authorities and collect and analyze regional information (Personal communication, October 10, 2018).

Health Canada – regional operations

Health Canada’s regional headquarters are situated in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Québec, and the Atlantic and Northern Regions (Health Canada, 2015).

CHIEF PUBLIC HEALTH OFFICER

Dr. Theresa Tam was named Canada’s Chief Public Health Officer in 2017 (Public Health Agency of Canada, 2018b).

As stated in the Public Health Agency of Canada Act, “The Chief Public Health Officer is the lead health professional of the Government of Canada in relation to public health” (Public Health Agency of Canada Act, 2006, section 7.1).

The Chief Public Health Officer is responsible for:

“Providing advice to the Minister of Health and President of the Public Health Agency of Canada on health issues;
Working with other governments, jurisdictions, agencies, organizations, and countries on health matters;
Providing an annual report to the Minister on the state of public health in Canada for tabling in Parliament; and
Speaking to Canadians, health professionals, stakeholders, and the public about issues affecting the population’s health” (Public Health Agency of Canada, 2016)

COLLABORATIVE MECHANISMS

Public health being a shared responsibility, collaborative structures have been put in place between different levels of the Canadian government and between stakeholders in different sectors.

Pan-Canadian Public Health Network

“The Pan-Canadian Public Health Network was established by Canada’s Federal, Provincial and Territorial (F/P/T) Health Ministers in 2005, as a key intergovernmental mechanism to:

Strengthen and enhance Canada’s public health capacity,
Enable F/P/T governments to better work together on the day-to-day business of public health, and
Anticipate, prepare for, and respond to public health events and threats” (Pan-Canadian Public Health Network, 2016).

See the following governance structure.

REFORMS

2016 – Changes to Public Health Agency of Canada

The role of the Chief Public Health Officer (CPHO) is formally split into two positions: the CPHO and the President of the Public Health Agency of Canada. The CPHO continues to provide scientific advice to the government, while the President serves as the deputy head of the Agency (under the Minister of Health) (Fafard & Forest, 2016).

2011 – Pan-Canadian Public Health Network

The Pan-Canadian Public Health Network was established by Canada’s Federal, Provincial and Territorial (F/P/T) Health Ministers in 2005. Its governance structure is modified in 2011 to centre around three existing steering committees (healthy people and communities, communicable and infectious disease and infrastructure) (Pan-Canadian Public Health Network, 2012).

2006 – Public Health Agency of Canada Act

This Act establishes the Public Health Agency of Canada and creates the appointment of a Chief Public Health Officer (Public Health Agency of Canada Act, 2006).

REFERENCES

Butler, M. & Tiedemann, M. (2011). The Federal Role in Health and Health Care. Publication No. 2011-91-E. Canada: Library of Parliament. Retrieved from: http://publications.gc.ca/collections/collection_2018/bdp-lop/eb/YM32-5-2011-91-eng.pdf

Canadian Food Inspection Agency. (2018a). About the Canadian Food Inspection Agency. Consulted on October 22, 2018: http://inspection.gc.ca/about-the-cfia/eng/1299008020759/1299008778654

Canadian Food Inspection Agency. (2018b). Inspection Capacity. Consulted on October 22, 2018: http://www.inspection.gc.ca/about-the-cfia/inspection-capacity/eng/1521596857393/1521596949071

Canadian Institutes of Health Research. (2010). 2011 Quinquennial Review – Terms of Reference. CIHR Act, section 4. Consulted on October 22, 2018: http://www.cihr-irsc.gc.ca/e/41678.html

Canadian Institutes of Health Research. (2017). About the Institutes. Consulted on October 22, 2018: http://www.cihr-irsc.gc.ca/e/7155.html

The Constitution Act of 1867. 1867, 30 & 31 Vict, c 3. Retrieved from: http://www.canlii.org/en/ca/laws/stat/30—31-vict-c-3/latest/30—31-vict-c-3.html

Fafard, P. & Forest, P.-G. (2016). The loss of that which never was: Evaluating changes to the senior management of the Public Health Agency of Canada. Canadian Public Administration, 59(3). Retrieved from: https://doi.org/10.1111/capa.12174

Forest, P.-G. & Martin, D. (2018). Fit for Purpose: Findings and Recommendations of the External Review of the Pan-Canadian Health Organizations. Retrieved from https://www.canada.ca/content/dam/hc-sc/documents/services/health-care-system/reports-publications/health-care-system/findings-recommendations-external-review-pan-canadian-health-organization/findings-recommendations-external-review-pan-canadian-health-organization.pdf

Health Canada. (2011). About mission, values, activities. Consulted on October 22, 2018: https://www.canada.ca/en/health-canada/corporate/about-health-canada/activities-responsibilities/mission-values-activities.html

Health Canada. (2014). About Health Canada. Consulted on October 22, 2018: https://www.canada.ca/en/health-canada/corporate/about-health-canada.html

Health Canada. (2015). Regions, Branches and Offices. Consulted on October 22, 2018: https://www.canada.ca/en/health-canada/corporate/contact-us/regions-branches-offices.html

Health Canada. (2017). Health Portfolio. Consulted on October 22, 2018: https://www.canada.ca/en/health-canada/corporate/health-portfolio.html

Health Canada. (2018a). Health Care System. The role of government. Consulted on October 22, 2018: https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html#a5

Health Canada. (2018b). Branches and agencies. Consulted on October 22, 2018: https://www.canada.ca/en/health-canada/corporate/organizational-structure.html#s2

Medlar, B., Mowat, D., Di Ruggiero, E., & Frank, J. (2006). Introducing the national collaborating centres for public health. Canadian Medical Association Journal, 175(5), 493-493. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550741/

National Collaborating Centres for Public Health. (2018). About Us. Consulted on October 22, 2018: http://nccph.ca/about-us/

Pan-Canadian Public Health Network. (2012). New Pan-Canadian Public Health Network governance structure in effect. Consulted on October 22, 2018: http://www.phn-rsp.ca/phngs-sgrsp-1104-eng.php

Pan-Canadian Public Health Network. (2016). Overview. Consulted on October 22, 2018: http://www.phn-rsp.ca/index-eng.php

Patented Medicine Prices Review Board. (2018). Mandate and Jurisdiction. Consulted on October 22, 2018: http://www.pmprb-cepmb.gc.ca/about-us/mandate-and-jurisdiction

Public Health Agency of Canada. (2016). The role of the Chief Public Health Officer. Consulted on October 22, 2018: https://www.canada.ca/en/public-health/corporate/organizational-structure/canada-chief-public-health-officer/role-chief-public-health-officer.html

Public Health Agency of Canada. (2017). About the Agency. Consulted on October 22, 2018: https://www.canada.ca/en/public-health/corporate/mandate/about-agency.html

Public Health Agency of Canada. (2018a). Organizational Structure. Consulted on October 22, 2018: https://www.canada.ca/en/public-health/corporate/organizational-structure.html

Public Health Agency of Canada. (2018b). Dr. Theresa Tam. Chief Public Health Officer. Consulted on October 22, 2018: https://www.canada.ca/en/public-health/corporate/organizational-structure/canada-chief-public-health-officer.html

Public Health Agency of Canada Act, S.C. 2006, c. 5. Retrieved from: http://laws-lois.justice.gc.ca/eng/acts/P-29.5/FullText.html

Acknowledgements

We would like to thank Caroline Cawley (University of Toronto) for conducting the initial online data collection for the present revision of the profile.

We would also like to thank the following reviewers for their assistance during the validation process: the Office of the Chief Medical Officer of Health, New Brunswick Department of Health; the Risk Management-Health Promotion Branch, Nova Scotia Department of Health and Wellness; Public Health Services, Nova Scotia Health Authority; the Chief Medical Officer of Health and the Public Health Manager of the Public Health Unit, Population Health Branch, Newfoundland and Labrador Department of Health and Community Services; the Public Health Agency of Canada.

Structural Profile of Public Health in Canada: Indigenous Health

This other section of the Structural Profile of Public Health in Canada is designed to examine structures dedicated to Indigenous health in Canada. To learn more, click here.

Structural Profile of Public Health in Canada

Alberta

British Columbia

Manitoba

New Brunswick

Newfoundland and Labrador

Québec

Northwest Territories

Nova Scotia

Nunavut

Ontario

Prince Edward Island

Saskatchewan

Yukon

Canada

Resources of Interest