Enhancing Capacity for Surveillance of Healthy Living & Chronic Disease in Canada Paula Stewart MD, FRCPC Public Health Agency of Canada APHEO, September

PHAC Mission and Vision Mission To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health Vision Healthy Canadians and communities in a healthier world.

PHAC Mandate (1) Anticipate, prepare for, respond to and recover from threats to public health; Carry-out surveillance, monitor, research, investigate and report on diseases, injuries, other preventable health risks and their determinants, and the general state of public health in Canada and internationally;

PHAC Mandate (2) Use the best available evidence and tools to advise and support public health stakeholders nationally and internationally as they work to enhance the health of their communities Provide public health information, advice and leadership to Canadians and stakeholders Build and sustain a public health network with stakeholders.

PHAC: Organization Chief Public Health Officer of Canada – Dr David Butler-Jones Centre for Health Promotion (CHP) Centre for Chronic Disease Prevention and Control (CCDPC) Centre for Infectious Disease Prevention and Control (CIDPC) Centre for Emergency Preparedness and Response (CEPR) Office of Public Health Practice Laboratory for Foodborne Zoonoses (LFZ) National Microbiology Laboratory (NML) Regions

Health Surveillance The tracking and forecasting of any health event or health determinant through the continuous collection of high-quality data, the integration, analysis and interpretation of those data into surveillance products (such as reports, advisories, warnings) and the dissemination of those surveillance products to those who need to know. Surveillance products are produced for a specific public health purpose or policy objective.

Public Health Agency Context Risk factor, chronic diseases – a priority Health goal with objectives and targets. Reporting on the health of Canadians. Reporting on Pan-Canadian initiatives such as Healthy Living and Diabetes Public health units need help – “Public health renewal” Work in partnership “facilitator”

Vision: Surveillance Canadians have reduced burden of chronic disease as a result of changes in policy, programs and services based on timely surveillance.

IDEAL SURVEILLANCE SYSTEMIndicatorFramework Data Collection/ Collection/Collation Data Analysis/ InterpretationSurveillance Products and Dissemination Action Based on Information ManagementCoordination/Collaboration Legislation & Regulation Policies Programs Services Improve health of the population Need Population Information

Scenario A : Unaware, lack of culture, lack of resources IndicatorFramework Data Collection/ Collection/Collation Data Analysis/ InterpretationSurveillance Products and Dissemination ManagementCoordination/Collaboration Legislation & Regulation Policies Programs Services Improve health of the population

Scenario B: Data not there Data Collection/ Collection/Collation Data Analysis/ InterpretationSurveillance Products and Dissemination ManagementCoordination/Collaboration Legislation & Regulation Policies Programs Services Improve health of the population Need Population Information IndicatorFramework

Scenario C: Can’t access IndicatorFramework Data Collection/ Collection/Collation Data Analysis/ InterpretationSurveillance Products and Dissemination ManagementCoordination/Collaboration Legislation & Regulation Policies Programs Services Improve health of the population Need Population Information

Scenario D: can’t interpret, culture lacking IndicatorFramework Data Collection/ Collection/Collation Data Analysis/ InterpretationSurveillance Products and Dissemination ManagementCoordination/Collaboration Legislation & Regulation Policies Programs Services Improve health of the population Need Population Information

Goal To improve capacity in Canada for surveillance of chronic disease, its risk factors and determinants.

Outcomes Public health organizations conduct surveillance using data from existing population databases, and use the information in decision-making. Public health organizations have access to surveillance data collection systems that are timely, rapid and flexible to meet their information needs, and use this information in decision-making. Administrative and clinical databases are used effectively for surveillance purposes.

Outcomes (continued) Data users and data owners from health and other related sectors, such as recreation, education, transportation and social services, work collaboratively to increase data availability and its use for chronic disease risk factor and determinants surveillance. The public health environment encourages the use of surveillance information in decision-making. Coordination of surveillance supports public health organizations surveillance activity.

Action Areas #1 Enhance Federal, P/T and local/regional capacity to analyse, interpret and use surveillance data. #2 Expand data sources to fill gaps in knowledge. #3 Enhance collaboration, planning and evaluation among all stakeholders. #4 Build capacity across jurisdictions for congruent public health legislation supportive of chronic disease surveillance.

#1 Enhance Federal, P/T and local/regional capacity to analyse, interpret and use surveillance data. Central coordinating function for resources (questionnaires, guidelines, validation, analyses) Access to existing surveys and databases (public health portal – tailored tables, maps, figures) E-learning, conferences, and workshops Facilitate surveillance support systems at regional level Public health human resource strategy

Healthy Living and Chronic Disease Surveillance Potential Data Sources Individual and Family Community environment Health Services Sentinel Centres Surveillance P/T Health Admin - physician billing, hospital, lab, drugs On-going Surveys -Central (CCHS, PAM, CTUMS, CLSCY) -Regional/local (RRFSS, RHS – First Nations) School, workplace, other Insurance Databases EAP, school, prison databases Administrative Databases - recreation, municipalities, housing, transportation, police, justice Mortality Databases Electronic Health Record Databases

#2 Expand data sources to fill gaps in data. Local/Regionally Directed Facilitate the development and sustainability of local/regionally coordinated on-going flexible data collection systems. (ala Ontario RRFSS) Provincially/territorially Directed Health administrative databases – build on NDSS, add regional analyses, add conditions Nationally Directed CCHS including Physical Measures Survey PAM – add more community environmental assessments Sentinel Centres - Primary health care networks

#3 Enhance collaboration, planning and evaluation among all the stakeholders. Pan-Canadian Public Health Network Issue Group - Surveillance of Healthy Living and Chronic Disease Coordinating function – PHAC

#4 Support the public health mandate for surveillance through legislation. Develop model public health legislation Facilitate jurisdictions to consider the model legislation when reviewing and revising their health legislation. Creation of a centre of expertise in public health law within the Public Health Agency of Canada, and a national interest group in public health law linked to the Public Health.

Next Steps Waiting for final approval and budget amounts Gradual ramp-up Immediate plans Expand NDSS to other conditions Regional Risk Factor Surveillance