A/HRC/41/34/Add.2 I. Introduction 1. The Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Dainius Pūras, visited Canada from 5 to 16 November 2018 at the invitation of the Government. The purpose was to ascertain, in a spirit of dialogue and cooperation, how the right to health is realized in the country. 2. The Special Rapporteur travelled to Ottawa, Winnipeg, Vancouver and Montreal. He met with the Ministers for Health and Indigenous Services of the Government of Canada and with a number of federal and provincial government representatives, such as the Chief Public Health Officer of Canada and provincial chief medical or health officers, as well as with officials in charge of health services at Correctional Service Canada, including the Correctional Commissioner. He also met with independent bodies, such as the Canadian human rights and mental health commissions, the Correctional Investigator, a provincial youth human rights commission and officials from a provincial ombudsman office. 3. The Special Rapporteur visited many health-care facilities, from community-based centres and clinics to large hospitals, and paid a visit to a high school in Montreal. He is grateful to the great number of committed civil society representatives, academics, professionals and psychiatrists with whom he met, not only in person in each city to which he travelled, but also remotely, including stakeholders from Fredericton, Halifax, Regina and Toronto. 4. The Special Rapporteur attested to the country’s complex policy and technical machinery for delivering health services and the different responsibilities and jurisdictions of the federal, provincial/territorial and municipal authorities. He is grateful to the Government of Canada for its full and high level of cooperation, in close coordination with provincial and local authorities. II. Right to health in Canada A. Background 5. Canada is politically structured as a constitutional monarchy, a parliamentary system, a federal system and a representative democracy. It has a federal Government for the entire country and provincial/territorial governments for its 10 provinces (Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Prince Edward Island, Quebec and Saskatchewan) and 3 territories (Northwest Territories, Nunavut and Yukon). The federal system bestows legislative and executive powers on those two levels, which are sovereign in their respective domains. Canada is officially a bilingual country. 6. Canada is the second largest country in the world but one of the least densely populated. Sixty-nine per cent of its 37.3 million people1 live in cities of more than 50,000 inhabitants. 2 By contrast, there are many remote and isolated communities that can sometimes only be reached by plane or ship. This remoteness has a negative impact on peoples’ accessibility of rights, including the right to physical and mental health. 7. Canada is a developed and advanced country, part of the Group of Seven most industrialized and largest economies worldwide. Overall well-being is high: in 2017, the human development index value for Canada was 0.926,3 above the average for countries in the very high human development group (0.894). Between 1990 and 2017, the country experienced notable increases in life expectancy at birth (by 5.2 years) and mean years of 1 2 3 See www.worldometers.info/world-population/canada-population. See www.oecd.org/cfe/CANADA-Regions-and-Cities-2018.pdf. See http://hdr.undp.org/sites/all/themes/hdr_theme/country-notes/CAN.pdf. 3