Canada - Country Profile

By PAHO/OPS, 16 September, 2022

The Health in the Americas+ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.

Environmental and social determinants of health

In 2000 the total population of Canada was 30 891 803 inhabitants; by 2024 this figure had risen to 39 742 430, representing a 28.7% increase. Regarding the country’s demographic profile, in 2024 people over 65 years of age accounted for 19.8% of the total population, an increase of 7.3 percentage points compared to the year 2000. In 2024, there were 101.4 women per 100 men and 131. older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country’s population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 65.1% of the total population of the country in 2024 (25 867 986 people). When we add these figures to the potentially passive population (6 005 606 under 15 years of age and 7 868 839 over 65 years of age), the result is a dependency ratio of 53.6 potentially passive people per 100 potentially active people. This ratio was 46.5 in 2000.

Life expectancy at birth in 2024 was 82.7 years, higher than the average for the Region of the Americas and 3.5 years higher that in 2000 (79.2).

Figure 1. Population pyramids of Canada, years 2000 and 2024

Between 2001 and 2021, the average number of years of schooling in Canada increased by 9.6%, reaching an average of 13.9 years in the latest year for which information is available. The unemployment rate in 2023 was 5.4%. Disaggregated by sex, the rate was 5.3% for women and 5.6% for men. In 2019, 0.2% of the population was living in poverty, defined as the percentage of the population with an income of less than US$ 2.15 per day; this is below the regional average of 2.6%.

During the period 2000-2022, the country improved its score on the Human Development Index, with an increase of 5.1% (from a score of 0.89 to a score of 0.935); during the same period, the index rose 14.6% internationally and 11.2% in Latin America (Figure 2).

Figure 2. Human Development Index in the Region of the Americas, 2022

In 2022, public expenditure on health accounted for 7.95% of gross domestic product (GDP) (Figure 3) and 19.18% of total public expenditure, while out-of-pocket spending on health accounted for 14.89% of total health expenditure.

Figure 3. Public expenditure on health as a percentage of gross domestic product in the Region of the Americas, 2021

Digital coverage

In 2021, 92.8% of the population had an internet connection, representing a considerable increase from 2000, when 51.3% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2019, infant mortality in Canada decreased from 5.3 to 4.4 deaths per 1000 live births, a decrease of 17% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 5.6% to 6.6% between 2000 and 2019.

Regarding the immunization strategy, measles vaccination coverage was 92% in 2022, a decrease of 3 percentage points from 2000.

Figure 4. Infant mortality per 1000 live births, 1995–2020

The maternal mortality ratio for 2020 was estimated at 11.0 deaths per 100 000 live births, a reduction of 18.4% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2024 women had an average of 1.3 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 73.7% decrease, from 17.1 live births per 1000 women aged 15 to 19 years in 2000 to 4.5 in 2024. Between 2007 and 2017, there was no variation in the percentage of prenatal care, which remained at 99%. In 2020, 98% of births were attended by skilled birth personnel.

Figure 5. Maternal mortality per 100 000 live births, 2000–2020

Communicable diseases

In 2022, there were 5 new cases of tuberculosis per 100 000 population in Canada. In parallel, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 0.1 in 2019 (0.1 in women and 0.2 in men).

In 2021, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 3.8 per 100 000 population. The age-adjusted mortality rate for HIV was 0.3 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 77.8%.

There were no cases of human rabies in the country in 2022.

Noncommunicable diseases and risk factors

In Canada in 2022, the prevalence of tobacco use among people aged 15 and older was 12.0%. In the same age group, the prevalence of overweight and obesity was 59.2% in 2022. In 2021, there were 5 new cases of tuberculosis per 100 000 population in Canada. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 0.1 (0.1 in women and 0.2 in men).

In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 13.2%, a decrease of 6 percentage points compared to 2000 (19.2%). The prevalence of diabetes mellitus, which stood at 5.4% in 2000, increased to 5.5% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in Canada was 125.6 deaths per 100 000 population, a decrease of 29.4% from a rate of 178 in 2000. Among potentially avoidable premature mortality, the rate for preventable causes was 80.9 per 100 000 population in 2019, which is 41% lower than the regional average rate; and the rate for treatable causes was 44.7 per 100 000 population, below the regional average of 89.6.

The overall age-adjusted mortality rate was 3.5 per 1000 population in 2019, a decrease of 25.7% compared to 2000 (4.7 deaths per 1000 population).

When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 18.6 per 100 000 population (20.7 per 100 000 in men and 16.6 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 301.5 per 100 000 population (354.9 per 100 000 in men and 254.7 per 100 000 in women). The rate of age-adjusted mortality from external causes was 26.8 per 100 000 population (37.3 per 100 000 in men and 16.6 per 100 000 in women), including road traffic accidents (4.6 per 100 000 population), homicides (1.6 per 100 000 population), and suicides (10.3 per 100 000 population). In 2000, the percentage distribution of causes was 87.9% for noncommunicable diseases, 4.9% for communicable diseases, and 7.2% for external causes; in 2019, the percentages were 86.9%, 5.3%, and 7.7%, respectively (Figure 6).

Figure 6. Proportional mortality in Canada, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 11.9 per 100 000 men; lung cancer, 30.9 per 100 000; and colorectal cancer, 14.6 per 100 000. In women, these values were 15.4 deaths per 100 000 for breast cancer, 24.4 per 100 000 for lung cancer, and 10.2 per 100 000 for colorectal cancer.

Perspectives

Achievements in Disease Elimination

Addressing stigma and discrimination remains a key priority for Canada and is highlighted in the Pan-Canadian STBBI Framework for Action and the renewed Government of Canada STBBI Action Plan (2024-2030). Canada continues to demonstrate leadership and is a proud supporter of Undetectable equals Untransmittable (U=U). Canada was the first country to endorse the U=U campaign in 2018 and the U=U global declaration and call-to-action in 2022. In 2023, as a follow up to the global endorsement, Canada launched a nationwide Knowledge to Action Strategy that promotes U=U and its integration into practice and provided funding for two U=U promotion projects.

First Nations, Inuit and Métis Peoples continue to be disproportionately impacted by HIV in Canada. In 2021, the rate of newly diagnosed HIV cases was three times higher among First Nations in Canada than in the overall Canadian population. Stigma and discrimination are ongoing barriers for First Nations, Inuit and Métis Peoples in accessing culturally safe STBBI prevention, testing, care, treatment, counselling and support. Canada’s National Microbiology Laboratory collaborates with local and federal partners to increase access to point of care testing for HIV and other STBBI for Indigenous Peoples living in remote and isolated communities. Canada also has dedicated funding rooted for off reserve Indigenous-led STBBI projects. Canada will continue to work collaboratively with Indigenous organizations, partners and communities to address the rising rates of HIV and other STBBI among Indigenous peoples.

Canada recognizes the critical role that community-based organizations play in its ability to achieve global targets, to reduce barriers, and to address systemic inequities affecting people living with or affected by HIV, Hepatitis B and C and other STBBI in Canada. In 2022-2024, Canada invested $26.5 million in time-limited funding to improve access to HIV self-testing. This included $16.6 million to support the purchase of HIV self-test kits and the creation of educational, training and promotional resources for community-based organizations and key populations. Funding also supported over 50 frontline organizations to distribute kits and resources, and provide linkages to care as required, to their key populations. This funding also supported the National Microbiology Laboratory to expand community-based and led testing in northern, remote, and isolated communities, and funding to the BC Centre for Disease Control (BCCDC) and British Columbia's First Nations Health Authority to build on previous COVID-19 testing initiatives by evaluating testing potential for other infectious diseases, including STBBI. Evidence demonstrated that HIV self-test kits reached first time testers.

The Canadian Institutes of Health Research Strategic Plan (2021–2031) focuses on making research inclusive, collaborative, transparent, culturally safe, and focused on real-world impact, with the aim of positioning Canada as a global leader in the science of achieving health equity. Specifically, the plan has five priorities, each with an equity focus, and these include accelerating the self-determination of Indigenous peoples in health research; pursuing health equity through research; and integrating evidence in health decisions.

The Canadian Institutes of Health Research (CIHR) funds peer reviewed research open to all disciplines of health research. We currently do not have specific initiatives targeted at the diseases covered by the PAHO Elimination Initiative. However, in the last 5 years (2018/19-2022/23), through CIHR open funding calls, our research investment in diseases targeted by the PAHO Elimination Initiative totals CAD 346.6 M (HIV/AIDS: CAD 216.2M, cervical cancer: CAD 32.2M, hepatitis C: CAD 68.6M, tuberculosis: CAD 29.6M)

Indigenous Services Canada’s (ISC) First Nations and Inuit Health Branch aims to provide sustainable, and culturally appropriate health programs and services that contribute to the reduction of gaps in health status between First Nations and Inuit and other Canadians. ISC supports partners in the prevention and control of vaccine preventable diseases (e.g. Measles, Rubella, Varicella), sexually transmitted and bloodborne infections (e.g. HIV/AIDS, hepatitis C, syphilis), respiratory infections (e.g. tuberculosis, RSV) and communicable disease emergencies (e.g. pandemic influenza, COVID-19).

Specific activities include public health measures to identify risks (e.g. surveillance, reporting); prevent, treat and control cases and outbreaks of communicable diseases (e.g. immunization, screening, directly observed therapy); support community-led culturally appropriate awareness to encourage healthy practices; and strengthen community capacity (e.g. pandemic plans).

Canada continues to work with Indigenous organizations, provincial and territorial governments, and other parties to address the social determinants of health, including housing, food security, income, and access to culturally-appropriate healthcare that contribute to the disproportionate communicable disease transmission among Indigenous Peoples in Canada.

Current Efforts and Roadmap to 2030 to the Disease Elimination

Vaccine Preventable Diseases:

Currently, Canada is in the process of renewing its National Immunization Strategy (NIS) for 2025-2030. The NIS provides a framework for interjurisdictional collaboration to improve the relevance, effectiveness, and efficiency of immunization programming in Canada, focusing on enabling consistent approaches to planning, purchasing, delivering vaccines and educating the Canadian public about immunization. NIS renewal is revisiting the ten Priority Areas that have been foundational to the NIS since 2013, which include coordination of program schedules, program evaluation and research, vaccine surveillance, vaccine safety and vaccine confidence and uptake. Canada will maintain ongoing cross-jurisdictional collaboration to address the continuing and emerging threats from vaccine preventable diseases.
As part of the National Immunization Strategy objectives for 2016-2021, Canada’s vaccination coverage goals and vaccine preventable disease reduction targets by 2025 were set based on international standards and best practices. The goals and targets are consistent with Canada's commitment to the World Health Organization's (WHO) disease elimination targets and Global Vaccine Action Plan, while reflecting the Canadian context. The elimination targets include maintaining zero cases of polio, maintaining the elimination of endemic measles, maintaining the elimination of endemic rubella, and maintaining zero cases of Congenital Rubella Syndrome (CRS)/Congenital Rubella Infection (CRI) in Canada. Currently, Canada is in the renewal process of new goals and targets for 2025-2030. Publication is planned for early summer 2025.

HIV/AIDS and viral hepatitis epidemics:

To demonstrate Canada’s role and commitment to end the HIV/AIDS and viral hepatitis epidemics and to reduce the health impact of sexually transmitted infections by 2030, in 2018, federal, provincial and territorial ministers of health collaborated to release the Pan-Canadian Framework for Action on STBBI – Reducing the health impact of sexually transmitted and blood-borne infections in Canada in 2030: A pan-Canadian STBBI framework for action.

To advance the Framework on STBBI, in 2019 the Government of Canada released its five-year Action Plan on STBBI – Accelerating our response: Government of Canada five-year action plan on sexually transmitted and blood-borne infections (2019-2024).

In 2024, the Government of Canada released The Government of Canada’s sexually transmitted and blood-borne infections (STBBI) action plan 2024-2030. It aims to accelerate Canada’s efforts to prevent, diagnose and treat STBBI, and address barriers to care. The renewed STBBI Action Plan outlines 16 priorities, 49 actions, and indicators to measure progress. The 16 federal priorities align with the framework’s four core pillars of prevention, testing, initiation of care and treatment, and ongoing care and support, supported by the foundation of an enabling environment. The Action Plan reflects a whole-of-government approach with nine federal departments responsible for its implementation. To advance collective priorities on STBBI, Canada is committed to working with key populations and community partners.

Current efforts to accelerate TB elimination in Canada include:

working collaboratively with Indigenous Partners to support Indigenous communities in TB elimination interventions
completing national surveillance to monitor key trends in TB over time
providing surge support for outbreaks to jurisdictions requesting laboratory, epidemiology and/or logistical supports.
working together to continue to improve access to essential TB treatments that are not authorized for sale in Canada.

In April 2024, a time-limited TB Task Group was formed to enhance Federal, Provincial, Territorial, and Indigenous coordination and collaboration on TB elimination through the co-development of a TB Elimination Strategy for Canada. There is representation on this Task Group from all provinces and territories as well as from Inuit Tapiriit Kanatami, the Assembly of First Nations, and the Métis National Council. The Task Group reports to the Communicable and Infectious Disease Steering Committee (CIDSC) of the Pan-Canadian Public Health Network.

The development of a TB Elimination Strategy for Canada will identify the shared vision, priorities and opportunities for action for TB elimination and reaffirm Canada’s commitment towards TB elimination. The Task Group will comprehensively engage with civil society organizations and affected communities to develop the TB Elimination Strategy. TB elimination is defined as less than 1 notified TB case (all forms) per million population and year.

Challenges and gaps in relation to the four strategic lines of action of the Elimination Initiative

Strengthening and integration of health systems and services

On February 7th, 2023 the Government of Canada announced that it would provide $25 billion over ten years to provinces and territories to support shared health priorities through tailored bilateral agreements. As part of these agreements, provincial and territorial governments are asked to develop action plans that will describe how funds will be spent (incremental to existing spending) and how progress will be measured. An integrated, inclusive approach to investments in health service teams, the health workforce, and data and digital tools will help to meet the health and mental health needs of Canadians.

Through the Working Together plan, the Government of Canada will work collaboratively with provinces and territories to modernize the health care system with standardized health data and digital tools. This investment will help provide Canadians access their electronic health information, which is shared between the health professionals that they consult.

In March 2023, provinces and territories endorsed a Pan-Canadian Interoperability Roadmap, which sets the long-term path for achieving a more connected health system through the adoption of common data standards. Ongoing federal, provincial and territorial collaboration to support progress on interoperability, including the development and implementation of interoperable electronic health records and patient summaries across jurisdictions will be crucial for robust population health data that supports approaches to personalized and precision medicine.

Team-based care is essential in family health services as it leverages the diverse expertise of various healthcare professionals to provide comprehensive and personalized care. In this model, doctors, nurses, social workers, mental health specialists, and other professionals collaborate closely, creating a unified approach to patient care that is able to address the multifaceted needs of individuals and families. Through the plan, the Canadian Government identified that implementing integrated, team-based care was a priority. Certain provinces have established health teams, for instance, Ontario currently has 54 teams.

Strengthening health surveillance and information systems

Potential challenges and gaps may be identified in the Elimination Initiative's strategy for strengthening health surveillance and information systems, including via the Interoperability Road Map and Federal Provincial Territorial Joint Action Plan on Health Data and Digital Health.

The decentralized nature of the healthcare system in Canada poses a considerable organizational challenge when attempting to standardize data collection, reporting, and resource allocation. Managing data interoperability across jurisdictions is also a complex endeavor. Additionally, each province and territory have distinct privacy laws and regulations that must be observed, necessitating robust cybersecurity measures to ensure compliance.

Currently, there exists a deficiency in standardized data models, content models, and governance models to facilitate the harmonious integration of immunization data from various sources in Canada. The absence of these standardizations presents challenges in the integration and sharing of data, potentially resulting in incomplete or inaccurate detection, understanding and action on disease. As a consequence, the effectiveness of initiatives geared towards the elimination of diseases – and the tracking of progress towards that goal - may be compromised.

Technological infrastructure, tools, and expertise: Canada's health data systems are often built upon outdated and/or inconsistent technology, which impacts the ability to improve interoperability, data quality, and timely analysis for public health action.
Data Management and Quality Needs: Inconsistent data collection, transfer, and storage of data, and manual data management increases the risk of errors and delays the capacity for timely analysis.
Data governance and stakeholder stewardship: Gaps in formal data sharing agreements results in delays in reporting, inconsistent application of data standards, privacy concerns, and differing provincial regulations, which can hinder collaboration and the effective use of health data.

The public health surveillance landscape in Canada is a dynamic space which responds to continually evolving and expanding public health priorities. While significant progress has been made, a number of longstanding and foundational challenges have impacted the pace and success of surveillance strengthening efforts in Canada. Variation in legislation, policies, trust and culture around public health data collection, sharing and privacy continue to challenge efforts towards consistent, comprehensive and seamless health data collection and sharing across Canada’s federated health system. Other challenges related to outdated and inflexible information technology (IT) infrastructure, and a lack of fully established public health data standards and governance models continues to stymie progress in surveillance system interoperability, integrated disease surveillance, data linkage, and open, secure and timely access to public health data for decision making.

However, the primary gap that Canada faces with health surveillance and information as it pertains to the diseases listed for elimination (e.g., TB, HIV, HEPB/C, measles, STIs, rubella) is the lack of disaggregated data to inform equity analysis. Several of these diseases disproportionately affect people and communities living in vulnerable conditions, and decision-makers often lack the needed data to design the most effective or equitable public health interventions. As well, with some of the land’s Indigenous communities experiencing disproportionate disease burden. Canada continues to encounter gaps in Indigenous health and data sovereignty which enable community-based surveillance and community-led interventions in these communities. PHAC is currently undertaking efforts in several areas to address these gaps and challenges, including through four pillars of horizontal surveillance strengthening work: 1) surveillance collaboration and governance, 2) advancing surveillance integration, 3) supporting data linkage, and 4) prioritizing disaggregated data to support SGBA Plus and equity-informed analyses. These pillars will complement parallel Agency and pan-Canadian initiatives in public health data sharing, governance, standards, modernization and interoperability, and work towards a vision of timely, adaptable and collaborative public health surveillance in Canada, to improve health and reduce inequities for all people.

Migratory travel routes may compromise the surveillance activities, particularly in regions that serve as hubs for international travel and immigration, which can pose difficulties in monitoring and controlling the spread of these diseases. The constant influx of travelers from various parts of the world increases the risk of various diseases. Travelers with mild symptoms who do not seek healthcare may not be detected. Therefore, it could be challenging to effectively track potential cases and control the spread of the diseases.

Addressing environmental and social determinants of health

The Government of Canada recognizes that systemic racism, resulting from Canada’s colonial history, remains embedded in our country’s health systems and continues to have catastrophic effects on First Nations, Inuit and Métis individuals and communities. Cultural safety, recognizing Indigenous knowledge and supporting Indigenous-led health services are central to achieving the goal of eliminating anti-Indigenous racism in health systems.

One of the challenges Canada faces is ensuring that our healthcare system remains equitable and accessing for Indigenous and 2SLGBTQQIA+ Peoples.

Sustaining collaborative efforts and aligning policy priorities across sectors and different levels of government remain key challenges in addressing the environmental and social determinants of health. The Government of Canada recognizes these and other systemic challenges and barriers, and is taking steps to address them through initiatives, investments, and intersectoral action that aims to improve population health and reduce health inequities. The Government has taken a whole-of-government approach to improving the environmental and social determinants of health to advance health equity through initiatives such as integrating Gender-Based Analysis Plus and quality of life frameworks into federal policy-making. The Public Health Agency of Canada also supports measuring, monitoring, and reporting on health inequalities to ensure that actions on the environmental and social determinants of health are prioritized for populations that are disproportionately impacted by adverse health outcomes.

Strengthening governance, stewardship, and finance

The Government of Canada is committed to investing in the health care system and supporting provinces and territories in delivering better health care. In the 2023 federal budget, the Government committed close to $200 billion over ten years in health funding to provinces and territories. This includes $44 billion in new funding, $25 billion of which is going to address four shared health priorities. Through this plan, the Government of Canada will work collaboratively with provinces and territories on four shared health priorities:

Expanding access to family health services, including rural and remote areas
Supporting health workers and reducing backlogs for health services such as surgeries and diagnostics
Improving access to quality mental health, substance use and addictions services
Modernizing the health care system with standardized information and digital tools so health care providers and patients have access to electronic health information

The Government of Canada will also work with provinces and territories to help people in Canada age with dignity, closer to home, by supporting efforts to improve access to home and community care, and safe long-term care.

Under the bilateral agreements, provinces and territories agree to:

Develop action plans detailing their use of federal funds, set and measure targets, and provide annual progress reports.
Work together on workforce priorities, including simplifying the recognition of foreign credentials for internationally-trained health professionals and facilitating labor mobility so health care providers can work across different provinces or territories.
Enhance the collection, sharing, and the use of health information by:
- Gathering and securely sharing consistent data to improve health care in Canada.
- Adopting common standards to better integrate Canada’s health care system, including implementing the Shared Pan-Canadian Interoperability Roadmap.
- Aligning policies and legislative frameworks to support the use of health information for public benefit.
- Promoting person-centered principles from the Pan-Canadian Health Data Charter for managing health information.
- Improving the management of public health emergencies.

More information on specific provinces and territories bilateral agreements can be found on Health Canada’s website. With collaborative action and a dedicated focus on health care system improvements, patients will receive better care experiences.

Health Equity into the country's efforts for the Elimination Initiative

Canada has made significant investments to take action to foster health systems free from racism and discrimination where Indigenous Peoples are respected and safe.
Canada’s investments to address anti-Indigenous racism in health systems include initiatives that will improve access to high quality and culturally safe health services, including those for Indigenous women, 2SLGBTQQIA+ peoples, people with disabilities and other marginalized groups who are disproportionately impacted by anti-Indigenous racism.
Canada is currently supporting 158 Indigenous-led initiatives across all provinces and territories, including all distinctions, and in urban settings to improve access to high quality and culturally safe health services.
Canada will continue to work collaboratively and engage with Indigenous organizations and leaders, provincial and territorial governments and health system partners to identify concrete actions to address anti-Indigenous racism.
In response to the death of Joyce Echaquan and the powerful accounts of racism shared at an urgent national dialogue in October 2020, the Government of Canada has made investments to foster health systems free from racism and discrimination, where Indigenous Peoples are respected and safe. In addition, the Government of Canada has made investments in Atikamekw Nation and Manawan First Nation to support the implementation of Joyce’s Principle.
Joyce’s Principle aims to guarantee all Indigenous Peoples the right to equitable access to social and health services, as well as the right to enjoy the best possible physical, mental, emotional and spiritual health.
Canada is in the process of the renewal of Canada’s vaccination coverage goals and vaccine preventable disease reduction targets for 2025-2030. This collaborative effort among national, provincial, and territorial governments incorporates health equity by including Indigenous consultation and engagement. Canada also incorporates sex and gender-based analysis plus factors (which include biological sex, gender, geographic location, age, ethnicity, and social/behavioural risks factors) in routine disease surveillance programs (e.g., the Canadian Measles/Rubella Surveillance System).
Additionally, Canada’s National Immunization Technical Advisory Group (NITAG), the National Advisory Committee on Immunization (NACI), leverages a peer-reviewed published framework for the systematic consideration of ethics, equity, feasibility, and acceptability in vaccine program recommendations.

Per the Government of Canada’s Health Portfolio’s Sex- and Gender-Based Analysis Plus (SGBA Plus) Policy, PHAC systematically applies SGBA Plus to formulate and implement intersectional, responsive, and inclusive public health policies, programs, and initiatives that promote greater health equity for all people in Canada. The application of SGBA Plus emphasizes the need for disaggregated data and scientific evidence, meaningful partner and stakeholder engagement, and the use of inclusive and non-stigmatizing language, ensuring that potential barriers for diverse populations are identified and actions are identified to reduce barriers.

Canada endorsed the Rio Political Declaration on Social Determinants of Health in 2011, pledging to strengthen capacity, evidence and action on the social determinants of health and health equity. In particular, the Rio Political Declaration on Social Determinants of Health calls on countries to “monitor progress” towards reducing health inequities. To this end, the Government of Canada established the Pan-Canadian Health Inequalities Reporting Initiative (HIRI), which aims to strengthen the measurement, monitoring and reporting of health inequalities in Canada through improved access to data and the development of resources to improve knowledge of health inequalities. Data from HIRI inform action at various levels to reduce health disparities and promote equity across the country.

Community and Civil Society Participation

The Government of Canada acknowledges the challenges faced by Indigenous Peoples, including First Nations, Inuit and Métis in accessing culturally safe health care. Canada is committed to working in partnership to advance the priorities Indigenous Peoples put forward when it comes to health care. The mandate letter for the Minister of Indigenous Services commits to "fully implement Joyce's Principle and ensure it guides work to co-develop distinctions-based Indigenous health legislation to foster health systems that will respect and ensure the safety and well-being of Indigenous Peoples." It is part of the Government of Canada's commitment to address the social determinants of health and advance self-determination in alignment with the United Nations Declaration on the Rights of Indigenous Peoples.

The co-development of distinctions-based Indigenous health legislation is an opportunity to:

establish overarching principles as the foundation of federal health services for Indigenous Peoples
support the transformation of health service delivery through collaboration with Indigenous organizations in the development, provision and improvement of services to increase Indigenous-led health service delivery
continue to advance the Government of Canada's commitment to reconciliation and a renewed nation-to-nation, Inuit-Crown and government-to-government relationship with Indigenous Peoples based on the recognition of rights, respect, co-operation and partnership

Community and civil society participation are incorporated in Canada's efforts for the Elimination Initiative. For instance, during a recent increase in measles cases in Canada in early 2024, Canada utilized various communication methods to inform travelers and the public about the event. This included: targeted social media messaging and airports signage; Chief Public Health Officer statements and updating key webpages on Canada.ca; and sharing toolkits with the provinces/territories and vaccination centres to ensure coordinated messaging across the country.

Community partnerships help advance the work of the Government of Canada STBBI Action Plan and achieve global STBBI targets by providing innovative, tailored approaches to address STBBI that are free of stigma and discrimination. Annual investments of $33.4 million in community-based projects continue to be a pillar of Canada’s response through the HIV and Hepatitis C Community Action Fund and the Harm Reduction Fund.

The HIV and Hepatitis C Community Action Fund seeks to ensure that community-based efforts reach key populations, including people unaware of their HIV/hepatitis C status, and link them to testing, prevention, treatment and care and reduce stigma toward populations disproportionately affected by STBBI, including people living with HIV or hepatitis C. The Harm Reduction Fund (HRF) supports time-limited projects across Canada that help reduce HIV and hepatitis C among people who share injection and inhalation drug-use equipment. For example, over the past year the HIV and Hepatitis C Community Action Fund and the Harm Reduction Fund supported over 70 projects that address stigma toward HIV, Hepatitis C and other STBBI, and stigma toward those populations disproportionately affected.

Combating racism and discrimination is crucial for ensuring that prevention, treatment, and care are accessible to all Canadians. Canada values the role of community-based organizations in achieving global targets and addressing systemic inequities. In 2023, to update the Government of Canada STBBI Action Plan (2024-2030), the Public Health Agency of Canada engaged over 450 stakeholders, rights holders and partners through 50 activities, including surveys, discussions, and meetings, involving key populations, healthcare professionals, community organizations, and advocates.

Country Coordination Mechanisms in efforts to eliminate diseases

Health responsibilities in Canada are shared between federal and provincial/territorial (FPT) governments. The FPT Health Ministers’ meetings and the Pan-Canadian Public Health Network facilitate coordination in efforts to eliminate diseases. The Public Health Agency of Canada (PHAC) plays a central role in coordinating national efforts to prevent and control the diseases under elimination, including through efforts to increase vaccine update and acceptance. It works closely with provincial and territorial health authorities, as well as international partners. Furthermore, Canada has robust disease surveillance systems that integrate data from various sources to support the elimination initiative. The systems help in early detection and coordinated response efforts.

Addressing STBBI in Canada requires engagement at all levels of government. Federal, provincial and territorial (FPT) governments are refocusing efforts to address STBBI in Canada through a more coordinated approach that is respectful of post-COVID-19 pandemic realities, new testing approaches, and responsive to the needs of key populations.

The Communicable and Infectious Diseases Steering Committee (CIDSC) is the FPT table under Canada’s Public Health Network Council (PHNC) that aims to develop a cohesive and responsive national approach to communicable and infectious disease prevention and control.

In July 2019, in response to rising rates of syphilis across the country, a Federal-Provincial-Territorial-Indigenous (FPTI) group, the Syphilis Outbreak Investigation Coordinating Committee (SOICC) was established. SOICC members collaborate to provide enhanced surveillance data on infectious and congenital syphilis and advance related surveillance activities. Canada’s Public Health Agency is also leading the Syphilis Response Steering Committee (SRSC), a FPT tables that brings together representatives from provinces, territories, and the federal government in collaboration to develop and implement evidence-based responses and public health actions to reduce rates of infectious and congenital syphilis in across the country.

Conclusion

Summarize the main findings and action points for local authorities. This should include a clear call to action for continuous commitment and collaboration towards disease elimination by 2030. Emphasize the importance of sustained efforts, resource allocation, and multisectoral collaboration to maintain and accelerate progress.

Disease Details in the Elimination Initiative

The Health Situation and the Elimination Initiative Diseases

Please note that in Canada, the provincial and territorial governments are responsible for the management, organization and delivery of health care services for their residents. The federal government is responsible for setting and administering national standards for the health care system through the Canada Health Act, providing funding support for provincial and territorial health care services, supporting the delivery of health care services to specific groups, and providing other health-related functions.

Bacterial Meningitis Epidemics:

Through successful immunization programs, Canada has decreased the incidence of many invasive bacterial diseases, which contribute to a high burden of bacterial meningitis. Evidence of successful immunization programs include:

Invasive meningococcal disease (IMD): With the implementation of routine vaccination (for serogroups A, C, W, and Y), the average annual incidence of IMD declined from 0.8 cases per 100,000 population in the pre-vaccine era (1997-2001) to 0.3 cases per 100,000 population from 2017 to 2021. The average annual number of reported IMD cases has decreased by 58.5% in this timeframe.
Invasive pneumococcal disease (IPD): The average annual incidence rate of IPD increased from 6.4 cases per 100,000 population in the pre-vaccine era (2001) to 8.4 cases per 100,000 population from 2017 to 2021.
Invasive Haemophilus influenzae Disease, type b (Hib): Invasive Hib became a notifiable disease in Canada in 1986, so case count information is not available before Hib vaccines were introduced in Canada. However, estimates indicate there were approximately 2,000 cases annually in Canada before Hib vaccines. This represents a 99.2% decrease among the average number of reported invasive Hib cases in 2017 to 2021 compared to the pre-vaccine era.

Cervical Cancer:

The Public Health Agency of Canada provides funding to the Canadian Task Force on Preventive Health Care (Task Force), an independent arms-length group of experts in primary care and preventive medicine. The Task Force develops evidence-based guidelines to support primary care providers on a number of health topics, including cervical cancer. Guidelines for cervical cancer screening (published in 2013) are in the process of being updated.

In response to the WHO’s goal to eliminate cervical cancer as a global public health problem in this century, and to support the Government of Canada’s commitment to achieve this goal, the Canadian Partnership Against Cancer (CPAC), in collaboration with its partners, developed an Action Plan to Eliminate Cervical Cancer in Canada by 2040.

The Government of Canada funds the Canadian Partnership Against Cancer (CPAC) ($47.5M annually), a Pan-Canadian Health Organization created in 2007 based on the recommendation of cancer stakeholders and Provinces and Territories (PTs) that focuses its work on cancer prevention, early detection, treatment, and support for those living with cancer.
CPAC was established to provide a pan-Canadian perspective to cancer control and, specifically, to accelerate the implementation of the Canadian Strategy for Cancer Control (the Strategy). The objective of the Strategy and, by extension, CPAC, is to mobilize partners (PTs, Indigenous organizations, academics, patients, survivors, policy makers and others) from across the country to reduce the burden of cancer through coordinated, system-level practice and policy change.
Priorities include the improvement of HPV vaccination rates, transitioning from Pap screening to primary HPV screening, and enhanced efforts for follow up of abnormal results.
CPAC is now supporting Canadian jurisdictions to implement the Action Plan. In 2023 alone, CPAC initiated a funding opportunity to support provinces and territories (PTs) to accelerate action on primary HPV screening and follow-up implementation. It also organized and hosted a Pan-Canadian Summit on the Elimination of Cervical Cancer, bringing together over 150 partners from across all PTs to: share progress to date; offer solutions to address inequities and reconciliation in the work; and identify actionable next steps.
Additionally, CPAC entered into a new four-year funding agreement with the Urban Public Health Network to implement innovative HPV immunization strategies to better meet the needs of those who have not been reached by universal approaches to date.

Challenges and gaps in relation to the four strategic lines of action of the Elimination Initiative for cervical cancer:

The Canadian Cancer Registry (CCR) is the primary national surveillance system for invasive cervical cancer in Canada. The CCR is population-based, meaning provincial and territorial cancer registries are responsible for collecting and reporting their data. Current challenges and gaps include:
- reporting delays;
- changes in reporting standards over time that compromise timeliness and comparability;
- lack of capture of carcinoma in situ, and;
- a lack of information on the social determinants of health, treatment, and screen-detected cancer status.
To address these challenges, the Canadian Partnership Against Cancer and the Canadian Cancer Society have worked with partners throughout the Canadian Health and data systems to develop a pan-Canadian cancer data strategy that aims to:
- fill data gaps (e.g. social determinants of health);
- increase efficiencies in data collection to improve timeliness and quality of data;
- integrate data through linkages across data sources;
- promote and support First Nations, Inuit and Métis data sovereignty to improve data quality; and,
- increase access to and use of cancer data.
In addition, the Canadian Council of Cancer Registries, a collaboration between the 13 Canadian provincial and territorial cancer registries and Statistics Canada, guide the development, implementation, and evaluation of cancer registration standards and practices with the ultimate goal of optimizing data quality.

Congenital Syphilis:

Cases of confirmed early congenital syphilis have increased markedly from 4 cases in 2016 to 117 confirmed cases in 2022; the rate of congenital syphilis increased by 599% between 2018 and 2022

Hepatitis B and C:

In 2021, 3,524 cases of hepatitis B (acute, chronic, and unspecified cases combined) were reported for a rate of 9.2 cases per 100,000 people. Nearly half of people with chronic HBV in Canada may be unaware of their status.

In 2021, 7,535 cases of hepatitis C (acute, chronic and unspecified combined) were reported for a rate of 19.7 cases per 100,000 people.

At the end of 2021 in Canada, an estimated:

214,000 people were living with chronic hepatitis C. Of these, 59% were diagnosed.
262,000 people were living with chronic hepatitis B. Of these, 58% were diagnosed.

Between 2012 and 2021, an estimated 108,000 people living with chronic hepatitis C received treatment. Since the introduction of a treatment for hepatitis C that cures over 95% of people who take it, access to treatment has increased. Between 2015 and 2021, more people were treated and cured each year than there were new infections.

89% of 14-year-olds received one or more doses of the hepatitis B vaccine, as of 2021

Hepatitis C was identified as a contributing cause of death for 972 people in 2021. This represents 3 deaths out of 100,000 people.

Hepatitis B was identified as a contributing cause of death for 274 people in 2021. This represents 1 death out of 100,000 people.

Hepatitis B, mother to child transmission (HBV-MTCT)

The rate of total reported hepatitis B cases was 0.56 per 100,000 population in those aged less than 1 year of age in 2021.

HIV, mother-to-child transmission (HIV-MTCT)

In 2022, there were 239 infants who were perinatally exposed to HIV and there were six new perinatal infections. Of those who acquired HIV, two infants were born to individuals who did not receive any antiretroviral therapy (ART), three were born to individuals who received some or partial ART and one was born to an individual whose ART status was unknown.

HIV/AIDS

Canada continues to support the Government of Canada’s sexually transmitted and blood-borne infections (STBBI) action plan 2024-2030. Canada also supports the UNAIDS 95*95*95 treatment targets by supporting new testing technologies such as Dried Blood Spot Screening, HIV-syphilis rapid testing and HIV self-testing to facilitate access to culturally safe HIV and other STBBI testing, treatment and care.

Canada remains committed to advancing the priorities related to STBBIs as identified by Indigenous organizations, partners, and communities. Indigenous Services Canada (ISC) provides ongoing support to various national Indigenous organizations, including Pauktuutit Inuit Women of Canada, through initiatives such as the Tavva – National Inuit Sexual Health Strategy and the National Inuit Sexual Health Network. Additionally, ISC collaborates with the Communities, Alliances & Networks (CAAN) to promote leadership among women, youth, and men, identify effective practices, and enhance community preparedness in addressing HIV.

Canada makes significant investments under the Federal Initiative to Address HIV/AIDS in Canada. As part of this investment, Canada also provides support through regional and national Indigenous organizations who develop community led, community driven distinctions-based initiatives.

There were an estimated 65,270 people living with HIV (PLHIV) in Canada at the end of 2022. Among these people:

89% of PLHIV were diagnosed
85% of people diagnosed with HIV were on treatment
95% of people on HIV treatment had a suppressed viral load

An estimated 1,848 new infections occurred in Canada in 2022. This is a 15% increase from the estimate for 2020 (1,610). New infections occurred more frequently in some populations compared to the general population. The estimated 2022 HIV incidence rates (per 100,000 people) were:

5 per 100,000 in the overall Canadian population (6 in males and 3 in females)
494 per 100,000 among people who have injected drugs in the past 6-12 months
187 per 100,000 among sexually active gbMSM

The rate of new diagnoses of HIV was 4.7 per 100,000 population in 2022. This is not a measure of incidence.

Sexually Transmitted Infections:

Sexually transmitted and blood-borne infections (STBBI) remain a public health concern in Canada, despite them being largely preventable, treatable and in many cases, curable. Canada has taken steps to promote progress toward reaching global targets to reduce HIV, hepatitis B and C, infectious and congenital syphilis and other STBBI by 2030.

In 2018, the federal, provincial and territorial governments launched the Pan-Canadian Framework for Action on STBBI. The Framework includes a vision, guiding principles and pillars for action to achieve three strategic goals: 1) reduce the incidence of STBBI in Canada; 2) improve access to testing, treatment and ongoing care and support; and 3) reduce stigma and discrimination that creates vulnerabilities to STBBI.

With the publication of the Pan-Canadian Framework for Action on STBBI in 2018, Canada made a strategic shift to take an integrated approach to addressing STBBI rather than siloed disease-specific approaches. The intention is to take into consideration the common features of STBBI (e.g., risk factors, transmission routes, co-infections, social determinants of health, populations disproportionately affected by STBBI), while recognizing that disease-specific approaches may be appropriate in some cases.

As such, the renewed Government of Canada STBBI Action Plan (2024-2030) takes an integrated approach and aims to accelerate Canada’s efforts to prevent, diagnose and treat STBBI, and address barriers to care., and outlines federal priorities and actions for implementing the 2018 Framework. The renewed Action Plan outlines priority areas for federal government action – from research to data monitoring and collection to promotion and uptake of prevention and testing to harm reduction and access to care. This includes 16 priorities and 49 actions with established indicators to measure progress.

In Canada, there has been a lack of progress towards STBBI elimination. Similar to other countries, bacterial STI (chlamydia, gonorrhea, and syphilis) rates have been rising rapidly. Rates of hepatitis B and C, as well as HIV have not decreased in line with global targets. Since 2012, yearly cases and rates of HIV diagnoses in Canada have largely remained stable. Reported rates of acute HBV and cases of HCV have been relatively stable in recent years, despite an effective vaccine for preventing HBV and curative treatment for HCV. Other common STBBI, such as HSV 1, HSV 2 and HPV have limited incidence and prevalence data, yet continue to be of concern given their impact on health, stigma, quality of life, and their role in increasing the risk of acquiring or transmitting other STBBI, such as HIV.

Infectious syphilis rates increased by 109 % between 2018 and 2022, and outbreaks have been declared in ten provinces and territories in 2018 and 2019. The increased burden of disease (including increases in congenital syphilis) in recent years can be explained by the increase among heterosexual populations and females.

In 2021, the national rate of chlamydia was 273.2 per 100,000 people. Reported rates of chlamydia increased by 22% between 2012 and 2019 in Canada

The national rate of gonorrhea in 2021 was 84.2 per 100,000. The proportion of tested gonorrhea isolates identified as multi-drug resistant increased from 8.6% in 2015 to 12.4% in 2019

The Government of Canada’s five-year action plan on STBBI (2019-2024) committed to reporting on progress annually and showcasing the federal government’s efforts to reduce the public health impact of STBBI. Over the past year, the Government of Canada funded Indigenous-led community interventions that weave together traditional medicines with Western healing practices. Canada also endorsed the global declaration on Undetectable = Untransmittable (U=U), building on Canada's leadership as the first country to formally endorse the U=U campaign in 2018. These are only a few examples; other contributions can be found in the latest progress report. Past progress reports include the 2020-2022 Progress Report and the 2019-2020 Progress Report.

In Canada, there is potential to accelerate progress toward STBBI elimination. Similar to other countries, bacterial STI (chlamydia, gonorrhea, and syphilis) rates have been rising rapidly. Rates of hepatitis B and C, as well as HIV have not decreased in line with global targets. Since 2012, yearly cases and rates of HIV diagnoses in Canada have largely remained stable. Reported rates of acute HBV and cases of HCV have been relatively stable in recent years, despite an effective vaccine for preventing HBV and curative treatment for HCV. Other common STBBI, such as HSV 1, HSV 2 and HPV have limited incidence and prevalence data, yet continue to be of concern given their impact on health, stigma, quality of life, and their role in increasing the risk of acquiring or transmitting other STBBI, such as HIV.

Malaria and Plague:

In Canada, only malaria cases are those that are imported, and no reported cases of plague from 1930 to 2022 (according to Canadian Notifiable Disease Surveillance System). Since these diseases are not endemic to Canada, we do not have an active elimination plan for either disease.

Tuberculosis:

In September 2023, at the United Nations General Assembly (UNGA), Canada re-affirmed its commitment to address TB in Canada and abroad. Canada’s commitments include global TB targets set by the World Health Organization (WHO) as part of the End TB Strategy and United Nations Sustainable Development Goals. In addition to endorsing the WHO strategies in 2014, Canada has also pledged to meet domestic targets which include: reducing the incidence by 50% (compared to 2016 rates) in Inuit Nunangat by 2025, eliminating Inuit TB in Inuit Nunangat by 2030, and eliminating TB across the country by 2035.

As part of the Government of Canada’s commitment to TB elimination, the Health Portfolio is involved with a number of key activities including:

National Surveillance: Monitoring and reporting on TB trends, including incidence rates and antimicrobial resistance, at the national level, and sharing surveillance reports with domestic and international partners.
Laboratory Services/Sciences: Reference and diagnostic services, laboratory standards, proficiency panels, drug susceptibility, whole genome sequencing.
Support for Extramural Research: The Canadian Institutes of Health Research (CIHR) is Canada’s federal funding agency for health research and has invested $30M over the last five years (2018-19 to 2022-23) towards TB research grants that are primarily investigator-initiated.
Outbreak Response: Supporting requests for assistance (e.g., community-wide screening in remote and indigenous communities), including mobilization of laboratory and medical assets, as well as epidemiological and logistical support.
Guidance: Supporting development of guidance for TB prevention and control by contributing to the Canadian TB Standards with the Canadian Thoracic Society and other policy guidance as required.
Knowledge Translation: Increasing awareness about TB prevention, surveillance, and treatment by hosting communications activities for public health/health care professionals, community members, TB academics, researchers.
International engagement: Supporting the 2023 United Nations High Level meeting on TB, travel contact notifications, collaborating with international partners to address TB issues.
Access to TB drugs: Supporting access to rifapentine through the Urgent Public Health Needs (UPHN) pathway. Collaborative work between Health Canada (HC), the Public Health Agency of Canada (PHAC) and Indigenous Services Canada (ISC) to find access for other TB medications that are not authorized for sale in Canada, due to limited market update and limited viability for pharmaceutical companies.
Policy Development: Convening a time-limited Federal, Provincial, Territorial and Indigenous Task Group under the Communicable and Infectious Disease Steering Committee (CIDSC) to support collaboration on TB elimination activities. Facilitating collaboration and reporting on federal policy and programing to address social and structural determinants of health impacting TB rates among key populations.

Canada collaborates with partners in the prevention and control of tuberculosis (TB).

In 2018, the Government of Canada made a commitment to Inuit for Inuit Nunangat TB elimination with an initial investment of $27.5 million over 5 years. In Budget 2023, the Government of Canada extended Inuit TB elimination funds, by allocating $16.2 million over three years to support tuberculosis elimination in Inuit Nunangat by 2030.
Canada has been supporting Inuit Tapiriit Kanatami and regional Inuit partners in their development of the Inuit Tuberculosis Elimination Framework, which guided the development and implementation of 4 regional action plans for Inuit Nunangat TB elimination.
Canada has provided and will continue to offer in-person and virtual support during tuberculosis outbreaks and community-wide screenings in First Nations and Inuit communities.
Since 2017, Canada has maintained an inventory of rifapentine to support rapid access to this short-course treatment for tuberculosis infection. Canada has been working with Provinces and Territories to support community capacity building and the access to technologies such as rapid point-of-care testing, interferon gamma release assays (IGRA), and digital X-rays, which are integral in bringing tuberculosis diagnosis closer to home.

Current efforts to accelerate TB elimination in Canada include:

working collaboratively with Indigenous Partners to support Indigenous communities in TB elimination interventions
completing national surveillance to monitor key trends in TB over time
providing surge support for outbreaks to jurisdictions requesting laboratory, epidemiology and/or logistical supports.
working together to continue to improve access to essential TB treatments that are not authorized for sale in Canada.

The development of a TB Elimination Strategy for Canada will identify the shared vision, priorities and opportunities for action for TB elimination and reaffirm Canada’s commitment towards TB elimination. The Task Group will comprehensively engage with civil society organizations and affected communities to develop the TB Elimination Strategy. TB elimination is defined as less than 1 notified TB case (all forms) per million population and year.
The Task Group coordinates with federal, provincial, municipal/regional government representatives, as well as civil society organizations and affected communities and community organizations in efforts to eliminate TB.
Coordination with National Indigenous Organizations and newcomer and migrant organizations is a priority as these are the key populations most impacted by TB.
Collaboration with international and regional bodies/organizations (WHO, PAHO, etc.)

The Public Health Agency of Canada (PHAC) has provided support with Community Wide Screening (CWS) in Nunavut to two communities in outbreak: Pangnirtung in 2023 and Naujaat in the spring of 2024. PHAC’s support included laboratory staff and equipment from National Microbiology Laboratory (NML), field epidemiologist deployments from CFEP (Canadian Field Epi Program) and help with planning, logistics, coordination of staffing requests through the OFMAR mechanism and technical expertise. These supports were recognized by Nunavut’s CPHO as being critical to the successful CWS effort in both communities. Strong collaborations, prior to and during community wide screening in Nunavut has highlighted that stigma and mistrust can be overcome.

The Inuit Tuberculosis Elimination Framework developed by Inuit Tapiriit Kanatami (ITK), with the associated Regional Action Plans, is an example of an initiative that has brought partners together to build on regional strengths and unique contexts to address public health priorities. The Government of Canada has much to learn from Indigenous-led initiatives.

PHAC has been working collaboratively with Indigenous organizations such as ITK and contributing towards TB elimination by:

completing surveillance reports specific to Inuit in Inuit Nunangat
providing reference and diagnostic laboratory services to support northern communities, including whole genome sequencing.
Supporting outbreak response in the North: PHAC continues to provide laboratory, epidemiological and logistical support, as requested by provinces and territories for TB outbreaks in Canada.

In addition, the Canadian Institutes of Health Research (CIHR) has been supporting research initiatives that focus on making structural changes to TB programming in Indigenous communities (e.g., Pathways to Health Equity for Indigenous Peoples Initiative) and that enhance Indigenous capacity, knowledge, and self-determination in research. CIHR and Inuit Tapiriit Kanatami have developed a joint work plan (2021-2025) on research supporting the implementation of the National Inuit Strategy on Research (NISR), including a key activity on TB elimination and aiming to enhance Inuit capacity, knowledge, and self-determination in research. This includes $6.4M to establish an Inuit Research Network to support the implementation of NISR. CIHR is also investing $3M over five years to the TAIMA TB wastewater study in Iqaluit, Nunavut, which aims to follow TB trends in wastewater to allow Inuit communities and their health providers to apply public health interventions to treat and stop TB transmission more effectively.

Measles, Rubella, and Congenital Rubella:

Measles, rubella and congenital rubella syndrome (CRS) have been eliminated in Canada since 1998, 2005 and 2000, respectively. Canada reverifies its elimination status for these diseases with PAHO on a regular basis, with the most recent reverification taking place in 2024.

Neonatal tetanus:

Maternal and Neonatal Tetanus was declared eliminated in the Region of the Americas in 2017, with no cases identified in Canada since at least 1995.

Surveillance challenge - Currently there is no formal surveillance system in place specifically for maternal and neonatal tetanus (MNT) as current national case definitions do not differentiate MNT from other tetanus. As such, to validate Canada’s status as having eliminated MNT, Canada actively searches for MNT through reviewing hospital admission records and working with health authorities to rule out MNT.

Poliomyelitis:

Wild poliomyelitis was certified as eliminated in 1994 in Canada, with the last case of wild poliomyelitis acquired in Canada in 1977.

The sources of the interagency indicators used in this profile can be found in this table.

For the latest data on health indicators for the Region of the Americas, be sure to visit the PAHO Core Indicators portal.

Country COVID-19 Perspective

The health situation and the COVID-19 pandemic

In Canada in 2020, there were a total of 497 978 cases of COVID-19, representing 13,048 per million population. In 2021, there were 1 516 911 identified cases, equivalent to 39 745 per million population. In 2022, there were 2 201 252 identified cases, equivalent to 1172.25 per million population. In 2020, there were 14,272 deaths directly caused by COVID-19 in people diagnosed with the disease, or 374.0 per million population; in 2021, 15 615 deaths were reported, or 409 per million. In 2022, 14 853 deaths directly caused by COVID-19 in people diagnosed with the disease, or 289 per million population. In 2020, Canada ranked 18th in the Region of the Americas in terms of the number of deaths from COVID-19, and 17th in 2022, with a cumulative 1 172 25 deaths per million population over the considered years (Figure 7).

According to estimates by the World Health Organization, there was a total of 16 984 excess deaths in 2020, or 45 per 100 000 population; a total of 5 210 deaths were estimated in 2021, for an excess mortality rate of 14 per 100 000.

As of 1 June 2022, at least one dose of COVID-19 vaccine had been given to 84.92% of the country’s population. As of 1 June 2022 (latest available data), 82% of the population had completed the vaccination schedule. The vaccination campaign began on 20 December 2020, and seven types of COVID-19 vaccine have been used to date.

Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to July 29th, 2023

Health risks from climate change

Climate change is negatively influencing the health of Canadians by driving the spread of infectious diseases, such as Lyme disease, while climate-related natural disasters and extreme weather events are increasing risks of injury or death and adversely affecting the wellness of Canadians.

Certain communities in Canada, including indigenous, racialized, and other marginalized individuals, as well as older adults and those with disabilities, face disproportionate climate change risks. To demonstrate, during the "heat dome" event in British Columbia in the summer of 2021, older adults faced a disproportionate impact. Specifically, of the 569 heat-related deaths recorded by the British Columbia Coroners Service, 69% were people aged 70 years or older. In addition, a growing body of international evidence points to chronic, long-term exposure to air pollution as a leading risk factor for the emergence of dementia, including Alzheimer's disease, most common in older adults. Canada is currently developing its first National Adaptation Strategy focused on bringing forward plans and collaborative actions to support climate change adaptation across the country.

Perspertives COVID-19

Measures to achieve universal health coverage

Canadian health care is mostly publicly financed and administered, with the federal government working closely with the provinces and territories, which have responsibility for healthcare delivery. Collectively, national standards are maintained through the Canada Health Act. The Act facilitates "reasonable access to health services without financial or other barriers," and represents an adoption of the global move toward universal health coverage. Canadian health care includes promotive, preventive, curative, rehabilitative, and palliative services, and recognizes that a strong primary healthcare system is essential to achieve universal health coverage. To ensure the long-term strength of the health system, the federal government is continuing its collaborative work with provinces and territories, focusing on five critical areas: (1) reducing healthcare backlogs and growing the health workforce; (2) easier access to a family health provider or team for all Canadians; (3) helping Canadians age with dignity closer to home and improving long-term care and home care services; (4) improving mental health and access to substance use services; and (5) modernizing health data and digital health.

Challenges related to population health

The Canadian population is aging, and the pace of this aging is predicted to continue. In 1980, the proportion of the Canadian population aged 65 and older was 9.4 percent. This proportion had increased to an estimated 18.0% by 2020, and is predicted to rise to 27.3% by 2060. Canadians continue to face health challenges, particularly related to an aging demographic, noncommunicable diseases. and mental health, along with emerging concerns related to communicable disease, antibiotic resistant infection, and climate-related health impacts. These challenges have been exacerbated by the ongoing COVID-19 pandemic. Cardiovascular disease, and cancers in 2019 were the top two causes of death and disability in Canada, collectively accounting for one-third of all healthy life lost. Over 3.4 million Canadians are living with diabetes, and more than 200 000 people are newly diagnosed each year. Indigenous peoples in Canada experience higher prevalence rates of many chronic diseases compared to the general Canadian population, and a particular concern is the excess and increasing levels of type 2 diabetes among First Nations children. Opioid and other substance overdoses are increasing; there were over 7 000 apparent opioid toxicity deaths in 2021 – about 21 deaths per day, up from 8 per day in 2016 and 12 per day in 2018. Solutions to each of these challenges require multisectoral cooperation as part of a resilient, agile, and sustainable health system.

COVID-19 pandemic response

Canada experienced seven distinct COVID-19 outbreak surges between April 2020 and May 2022, with many of the 44 000 confirmed deaths by August 2022 concentrated in these outbreak periods. COVID-19 has dramatically changed the paradigm of public health threat detection in Canada. Since 2020, Canada has made investments in public health surveillance, vaccination, public health measures, research, and other COVID-19 response components. Canada's response continues to demand an unprecedented level of public health surveillance, analysis, reporting, and advice.

Canada's plans to strengthen surveillance and public health guidance in the next 2–3 years include: improved recruitment and retention of subject-matter experts, including ongoing professional development and training; strengthened genomic sequencing and genomic surveillance; improved data collection and dissemination among Canada's federal, provincial, territorial, and municipal governments; implementation of new or enhanced information management and information technology systems; better integration of epidemiological, immunization, and laboratory data to support public health threat assessment; and identification of gaps in public health knowledge. In January 2022, Canada's Minister of Health announced the creation of the Centre for Research on Pandemic Preparedness and Health Emergencies, with an ongoing investment of Can$ 18.5 million per year. This research center aims to be a leader in preventing, preparing for, responding to, and recovering from existing and future pandemics and public health emergencies. It collaborates with other federal departments and agencies, as well as stakeholders domestically and internationally.

Measures to reduce inequalities in health

There is a national commitment to reducing health inequalities and three broad strategies have been identified to address the social, environmental, and economic determinants of health: (1) strengthening the evidence base to inform decision-making, (2) supporting community-based interventions, and (3) multisectoral collaborations beyond the health sector. A strong health-inequalities evidence base is anchored by the Pan-Canadian Health Inequalities Reporting Initiative, which provides online data tools and information products on health inequalities. The Canadian Institutes of Health Research Strategic Plan (2021–2031) focuses on making research inclusive, collaborative, transparent, culturally safe, and focused on real world impact, with the aim of positioning Canada as a global leader in the science of achieving health equity. Specifically, the plan has five priorities, each with an equity focus, and these include accelerating the self-determination of indigenous peoples in health research; pursuing health equity through research; and integrating evidence in health decisions. There is national support for community-based interventions to advance health equity. For example, the Intersectoral Action Fund supports communities to build local capacity for collaborative action on the social determinants of health and health inequities. The Promoting Health Equity: Mental Health of Black Canadians Fund supports community-based programs in mental health promotion to address the underlying determinants of health for black communities. The Healthy Canadians and Communities Fund invests in initiatives that address common risk factors (e.g., physical inactivity, unhealthy eating, tobacco use) with the aim of improving health and reducing health inequalities among priority populations at greater risk of major chronic diseases (diabetes, cardiovascular disease, and cancer). Canada is committed to working in partnership with indigenous peoples to co-develop indigenous health legislation to foster health systems that will respect and ensure the safety and well-being of indigenous people. This includes addressing the social determinants of health and advancing self-determination, in alignment with the United Nations Declaration on the Rights of Indigenous Peoples.