Children’s Health and the 

Environment in North America

A First Report on Available 

Indicators and Measures 

Country Report: Canada 

Prepared by the Government of Canada 
ii 

Library and Archives Canada Cataloguing in Publication 

Children’s Health and the Environment in North America: A First Report on Available 

Indicators and Measures. Country Report: Canada 

Also issued in French under title: La santé des enfants et l’environnement en Amérique 

du Nord : Premier rapport sur les indicateurs et les mesures disponibles. Rapport 

national : Canada. 

Includes bibliographical references: p. 59 

ISBN 0-662-42422-0 

Cat. no. En4-60/2005E 

1. Environmentally induced diseases in children--Canada. 

2. Children--Health risk assessment--Canada. 

3. Children--Health and hygiene--Canada. 

4. Environmental health--Canada. 

5. Pollution--Canada. 

6. Environmental monitoring--Canada. 

7. Environmental policy--Canada. 

8. Children and the environment. 

9. Health status indicators. I. Canada. Environment Canada 

RA407.5.C3C54 2005 614.4'271'083 C2005-980344-4 

For more information and to obtain copies of this document, free of charge: 

Enquiry Centre 

Environment Canada 

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purposes of resale or redistribution requires the prior written permission from the 

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or copyright.droitdauteur@communication.gc.ca. 

© Her Majesty the Queen in Right of Canada 2006
iii 

Table of Contents

Executive Summary ..........................................................................................................iv

1 Introduction............................................................................................................ 1

1.1 Context Indicators......................................................................................3

2 Asthma and Respiratory Disease.......................................................................... 6

2.1 Outdoor Air Pollution .................................................................................6

2.2 Indoor Air Pollution ..................................................................................14

2.3 Asthma ....................................................................................................17

3 Lead and Other Chemicals, Including Pesticides................................................ 20

3.1 Blood Lead Levels...................................................................................20

3.2 Lead in the Home ....................................................................................23

3.3 Industrial Releases of Lead and Selected Chemicals .............................26

3.4 Pesticides ................................................................................................41

4 Waterborne Diseases.......................................................................................... 44

4.1 Drinking Water.........................................................................................44

4.2 Sanitation.................................................................................................48

4.3 Waterborne Diseases..............................................................................51

5 Recommendations and Conclusions................................................................... 54

5.1 Recommendations for Improving Reporting on Indicators of Children’s 

Health and the Environment in North America ........................................54

5.2 Conclusions.............................................................................................58

References ...............................................................................................59

Acknowledgements......................................................................................................... 65

Appendix 1 List of Acronyms and Abbreviations ........................................................ 66

Appendix 2 Healthy Environments for Children—What You Can Do! ........................ 67

Appendix 3 Indicator Templates................................................................................. 77

Appendix 4 Indicators Steering Group—Canada ..................................................... 110 
iv 

Executive Summary

There are nearly 8 million children 19 years of age and under in Canada—representing 

approximately 25% of our population. Overall, indicators of Canadian children’s health are quite 

positive. Over the past 20 years, life expectancy at birth has increased, perinatal, neonatal and 

infant mortality rates have all decreased, the immunization rate for Canadian children has 

become one of the best in the world and the number of children born to teenage mothers has 

declined. Despite this generally favourable picture, there are some indications that Canadian 

children are facing risks to their health from the environment in which they live. 

The single leading cause of infant death in Canada is birth defects. After the first year of life, 

unintentional injuries are the leading cause of death for both boys and girls. Childhood cancer is 

one of the top three causes of death in children from 1 to 4 years of age. The incidence rates for 

several types of cancer have increased among young adults in Canada, which may be related to 

childhood exposures to environmental hazards. The leading causes of infant hospitalization are 

respiratory diseases, followed by perinatal conditions and digestive diseases. Children from 1 to 4 

years of age are most likely to be hospitalized due to illnesses of the respiratory system, digestive 

system and injuries. 

It is widely recognized that poverty is a major determinant of disproportionate exposure to 

multiple environmental hazards. Children living in poor families are more likely to live in areas of 

heavy traffic, to live in substandard housing and to be exposed to second-hand smoke in their 

homes. In 2001, 15.6% of children in Canada lived in families with income levels below the low 

income cut-off. 

The prevalence of asthma in Canada has increased fourfold over the past 20 years, to the point 

where more than 1 in 10 Canadian children have been diagnosed with asthma (indicator 3). Two 

factors related to the exacerbation of asthma are indoor and outdoor air quality. In terms of 

outdoor air quality, extensive epidemiological research has demonstrated that children are 

especially sensitive to air pollution. Exposure to air pollutants at various ambient levels has been 

associated with increased coughing and wheezing, increased use of airway medications, 

increased hospital visits by asthmatic children as well as harmful effects on lung growth, 

development and function. However, developing and portraying meaningful national measures of 

children’s exposure to air pollution remain a challenge in Canada. 

Existing information on ambient air quality shows that levels of several important air pollutants 

have dropped over the last 10 years in Canadian urban areas. Meanwhile, levels of ground-level 

ozone and fine particulate matter (PM2.5) are still of concern. In fact, levels of ground-level ozone 

in Canada are not decreasing. Southern Ontario experienced the highest numbers of days on 

which ground-level ozone and PM2.5 levels exceeded the Canadian standards. However, the 

population of Canadian children exposed to harmful levels of air pollutants cannot be accurately 

measured at this time (indicator 1). In contrast, we do know that many Canadian children 

continue to be exposed to second-hand smoke and other indoor air contaminants at home and in 

public buildings. In Canada, in 2002, 19% of children aged 0–17 were regularly exposed to 

second-hand smoke in the home (indicator 2). Generally, the proportion of children exposed to 

second-hand smoke in Canadian homes has been decreasing. 

Information on the extent of exposure of Canadian children to lead and other toxic chemicals is 

limited. Low-level or moderate lead exposure during early childhood can cause persistent 

adverse neurobehavioural effects, including cognitive deficits. There is no recent nationally 

representative sample of blood lead levels in Canadian children (indicator 4). Ingestion of lead in 

house dust is currently the major source of intake of lead for children. Older homes are more 

likely to contain lead in house dust from paint, and the risk of exposure is higher during 

renovations. Most indoor and outdoor paints produced before 1960 in Canada contained 

substantial amounts of lead. Thus, children living in housing stock built before 1960 may be at a 
v 

potential risk of exposure to lead. In 2001, 24% of Canadian children under 5 years of age lived in 

housing built prior to 1960 (indicator 5). Overall, total industrial releases of lead to the 

environment by reporting facilities decreased 46% between 1995 and 2000 in Canada (indicator 

6). 

There are many possible sources of children’s exposure to other chemicals. An indicator using 

pollutant release and transfer register (PRTR) data is provided as an “action” indicator to describe 

the effectiveness of preventive or remedial action in reducing emissions of toxic substances to the 

environment (indicator 7). Data for Canada are provided for 153 “matched” chemicals—those 

chemicals reported in the Canadian National Pollutant Release Inventory (NPRI) that are also 

required to be reported in the United States. The indicator shows that, overall, the number of 

facilities reporting to the NPRI increased from 1998 to 2002, while total pollutant releases 

decreased during this period. Of the four industrial sectors with the largest total releases, the 

primary metals and chemical manufacturing sectors reported reductions in releases between 

1998 and 2002, while the paper products and electric utilities sectors both reported increases in 

releases over the same period. 

Canada is also reporting separately on trends in emissions of seven pollutants selected because 

they are of specific concern to children’s health. The selected pollutants are arsenic, benzene, 

cadmium, chromium, dioxins and furans, hexachlorobenzene and mercury. 

Canada is reporting the yearly number of organophosphate pesticides detected on domestic and 

imported fruits and vegetables, expressed as a percentage of sample size (indicator 8). This 

indicator is a weak surrogate of children’s exposure to pesticides in foods because of the 

uncertainty inherent in the scope of the monitoring program. Over a several-year period, the 

percentage of fruits and vegetables with detectable organophosphate pesticide residues has 

decreased, suggesting reduced exposure from this source. 

This report contains case studies of research on subpopulations of children that may be 

disproportionately affected by environmental contaminants. We know that some segments of our 

population are exposed to unacceptably high levels of environmental pollutants. For example, the 

Northern Contaminants Program has found that some Inuit women from the North who eat 

traditional/country foods have levels of certain persistent organic pollutants and mercury in their 

bodies that are above Health Canada’s guidelines. Their infants may experience subtle 

neurodevelopmental effects as a result of exposures to these toxic substances in utero. Canada 

is working with the international community to decrease the levels of persistent organic pollutants 

and mercury in the environment. Although the consumption of traditional/country foods containing 

contaminants may be associated with greater exposures and health risks, it is important to 

recognize that diets containing these foods confer substantial nutritional benefits and are the 

foundation of the social, cultural and spiritual way of life for Canada’s Aboriginal peoples. 

As in many parts of the world, waterborne diseases continue to be of concern for children’s health 

in Canada. Numerous past outbreaks, together with recent studies, suggest that drinking water 

may be a substantial contributor to endemic (non-outbreak-related) gastroenteritis. In Canada, 

children aged 1–4 are more likely to be infected with the parasite Giardia than the rest of the 

population (indicator 12). Giardiasis, sometimes called “beaver fever,” is an intestinal parasitic 

infection characterized by chronic diarrhea and other symptoms. 

Approximately 78% of Canadians are served by central water distribution systems (indicator 9), 

although the percentage of children living in areas served by public systems in violation of local 

standards (indicator 10) is currently not available in Canada. Recent outbreaks in Walkerton, 

Ontario, and North Battleford, Saskatchewan—two communities on public distribution systems—

are reminding Canadians that vigilant management of drinking water and effective protection of 

sources continue to be of critical importance. An estimated 6.8 million Canadians rely on private 

water supplies, primarily groundwater wells. Some surveys indicate that between 20% and 40% 

of wells, particularly in rural areas, may be contaminated by nitrates or bacteria. 
vi 

Sanitary sewage, especially when it is not disinfected, can be an important source of pathogens 

to receiving water bodies. This presents a potential risk for children engaged in aquatic 

recreational activities, consuming contaminated shellfish or drinking untreated water in the area of 

influence of an outfall. Seventy-four percent of Canadians, living mostly in urban areas, are 

serviced by municipal sewer systems, with three-quarters of these Canadians being served by a 

high level of treatment (i.e., secondary or tertiary) (indicator 11). The remaining 26% of 

Canadians are assumed to be serviced by on-site septic systems.
1 

1 Introduction 

The physical environment, where children live, learn and play, is an important determinant of their 

health and well-being. Children are affected by environmental threats in all regions of the world, 

including Canada. When children suffer ill health because of a poor physical environment, hopes 

for improved quality of life and future development are stifled. 

Protecting Canadian children from environmental threats requires research, legislation and 

programs to reduce environmental hazards, outreach and education of parents and caregivers, 

and better information to track the environmental threats to children’s health. This report is 

concerned with the latter only—developing indicators to provide better information to track trends 

over time and measure the effectiveness of our interventions to protect the quality of the 

Canadian environment upon which children’s health and well-being depend. 

In June 2002, the environment ministers of Canada, Mexico and the United States, members of 

the Council of the North American Commission for Environmental Cooperation (CEC), agreed to 

a Cooperative Agenda to protect children from environmental risks. The Cooperative Agenda 

committed the three countries to selecting and publishing a core set of indicators of children’s 

health and the environment for North America. This commitment was reaffirmed in the CEC 

Council Session in June 2003, with the adoption of Council Resolution 03-10. A Steering Group 

was established, which applied the following criteria (CEC, 2003) in selecting indicators for the 

first North American report: 

• Useful and relevant. Each indicator must be related to a specific question or condition of 

interest that highlights a trend or caution regarding children’s health and the environment. 

• Scientifically sound and credible. Each indicator must be unbiased, reliable, valid and 

based upon high-quality data. The methodology for collecting the data should be robust and 

repeatable. There must be a credible link between the environmental condition that the 

indicator addresses and the health outcome (e.g., air quality and asthma rates). 

• Available. It is agreed that because not all countries will be able to report on all indicators, 

countries will choose indicators from this list that are most appropriate and available from 

their national perspective (e.g., whether or not nationally representative) and based on 

information that already exists, since governments may be unable to commit resources for 

collecting new data. 

• Applicable and understandable. The indicator must be useful for policymakers and a nonspecialist audience.

The Steering Group recommended that the three countries report on the following initial 12 

indicators of children’s health and the environment: 

• Indicator 1: Percentage of children living in urban areas where air pollution levels exceed 

relevant air quality standards 

• Indicator 2: Prevalence of asthma 

• Indicator 3: Measure of children exposed to second-hand smoke 

• Indicator 4: Blood lead levels 

• Indicator 5: Children living in homes with a potential source of lead 

• Indicator 6: Pesticides 

• Indicator 7: Pollutant release and transfer register (PRTR) data 

• Indicator 8: Percentage of children served with treated water 

• Indicator 9: Percentage of children served by drinking water systems in violation of local 

standards 

• Indicator 10: Percentage of children served with centralized sewage treatment 

• Indicator 11: Morbidity related to waterborne diseases 

• Indicator 12: Mortality related to waterborne diseases 
2 

An additional indicator of industrial emissions of lead was later added to the list. 

The Steering Group recommended the use of the World Health Organization’s Multiple Exposure 

– Multiple Effect (MEME) model (see Figure 1.1) to capture the complex interactions between the 

environment and children’s health. The MEME model highlights the fact that environmental 

exposures and health outcomes are based on many links between the environment and health 

and are rarely based on simple, direct relationships. The model illustrates that environmental 

exposures and health outcomes are influenced by social, economic and demographic factors 

(context). These are among a number of factors that are known to influence health outcomes and 

are frequently referred to as determinants of health. In this report, indicators in each of the four 

categories are presented—context, exposure, health outcome and action indicators. 

This is Canada’s contribution to the first report on indicators of children’s health and the 

environment in North America. Canada is reporting on the indicators recommended by the CEC 

Steering Group, based on available data at the national level. Canada was not able to provide 

information to populate some of the indicators recommended, while for other indicators, Canada 

is reporting additional information. In accordance with CEC Council Resolution 03-10, Canada 

resolves to continuously improve the quality and comparability of indicators and data across 

North America in subsequent reports. The list of Canadian Steering Group members that 

produced this report can be found in Appendix 4. 

For tips on what you can do to protect children’s health and the environment, please consult the 

tip sheet included in Appendix 2, also available at: 

http://www.hc-sc.gc.ca/hl-vs/pubs/child-enfant/child_safe-enfant_sain_e.html 

Figure 1.1: Multiple Exposure – Multiple Effect (MEME) framework 

Source: Briggs (2003) 

Well-being

Morbidity 

Mortality 

Exposure 

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions 

Remedial 

actions 

Actions

Contexts

Distal 

Proximal 

Less 

severe 

More 

severe 

Social conditions

Economic conditions 

Demographic conditions 

causes or 

is 

associated 

with 

attributable 

to or is 

associated 

with 
3 

MEME MODEL 

CONTEXT INDICATORS 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal

Proximal

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

1.1 Context Indicators 

1.1.1 Overview of Population Demographics 

There are nearly 8 million children 19 years of age and under in 

Canada. Children below 4 years of age represent 5.4% of the 

Canadian population, while children below 20 years of age 

represent approximately 25% of the population (Statistics Canada, 

2001a). A greater proportion of children live in urban areas, as 

79.7% of the Canadian population lived in urban areas in 2001 

(Statistics Canada, 2003). 

Figure 1.2: Age pyramid of population of Canada, 2001 

(shown in 000s) 

Source: Statistics Canada (2001b) 

In 1990, the crude birth rate in Canada was 15 live births per 1000 population; by 1995, it was 13 

live births per 1000 population, and by 2000, it was 10.7 live births per 1000 population. From 

1990 to 2000, births to teenagers, particularly young teenagers, decreased. The proportion of 

women who are delaying childbearing to later in life has increased markedly in Canada in recent 

years1

 (Health Canada, 2003a). The implication for environmental health is that older women 

 

1

 The age-specific live births among older mothers is defined as the number of live births to women 30–34, 

35–39, 40–44 or 45 years and older per 1000 females of the same age group (in a given place and time). A 

related indicator is the proportion of live births to older mothers, which refers to the number of live births to 
4 

have had a longer period of time to accumulate persistent environmental chemicals in their 

bodies from occupational and other exposures. Their infants potentially have greater exposures 

to contaminants in utero as a result of increased maternal body burdens (Hu et al., 1996; Rhainds 

et al., 1999; Hertz-Piciotto et al., 2000). 

1.1.2 Child Mortality and Morbidity 

The infant mortality rate decreased from 6.5 per 1000 live births in 1990 to 5.1 per 1000 live births 

in 2001. In 1999, the single leading cause of infant death in Canada was birth defects, accounting 

for 26.5% of all infant deaths, followed by immaturity and sudden infant death syndrome (SIDS). 

The total incidence of birth defects has been stable over recent years. The incidence of neural 

tube defects has declined over the past decade—due in part to increased intake of folic acid from 

fortified foods and use of vitamin supplements—but the number is still a concern (Health Canada, 

2003a). There is limited evidence linking environmental exposures to major birth defects (Wigle, 

2003). 

The mortality rate for children from 1 to 4 years of age was 0.4 per 1000 in 1990 and 0.2 per 1000 

in 2001 (CICH, 2000: 75). After the first year of life, unintentional injuries are the leading cause of 

death for both boys and girls (CICH, 2000: 74, 106, 107). This means that many deaths during 

this period may have resulted from predictable, preventable events. Childhood cancer is one of 

the top three causes of death in children from 1 to 4 years of age (CICH, 2000: 74). Apart from 

ionizing radiation, no definite links have been established between childhood cancers and 

environmental exposures; there is limited and non-conclusive evidence for links to parental 

prenatal and childhood exposures to pesticides. The incidence rates for several types of cancer 

have increased among young adults in Canada, which may be related to childhood exposures to 

environmental hazards. For example, melanoma rates (sun exposure early in life is a contributor 

to melanoma later in life), thyroid cancer (medical x-rays), testicular cancer (unexplained) and 

non-Hodgkin’s lymphoma (several possible environmental links) have all increased significantly 

(Wigle, 2003). The third leading cause of death in Canadian children from 1 to 4 years of age is 

birth defects. 

For children from 5 to 9 years of age, unintentional injury and childhood cancer remain leading 

causes of death, with the third being diseases of the nervous system (CICH, 2000: 106). Leading 

causes of death for children from 10 to 14 years of age include injuries (52%), cancer (13%) and 

diseases of the nervous system (7%) (CICH, 2000: 107). Among male youth from 15 to 19 years 

of age, leading causes of death include injuries (75%), cancer (6%), nervous disorders and birth 

defects (3%). Among females in this age group, leading causes of death include injuries (66%), 

cancer (10%) and circulatory diseases (10%) (CICH, 2000: 113). 

The leading causes of infant hospitalization have not changed in over a decade. The main cause 

of hospitalization in children less than 1 year of age is respiratory diseases (34%), followed by 

perinatal conditions (19%) and digestive diseases (8%) (CICH, 2000: 47). Children from 1 to 4 

years of age are most likely to be hospitalized due to illnesses of the respiratory system (41%), 

digestive system (10%) and injuries (9%) (CICH, 2000: 74) The main causes of hospitalization for 

children from 5 to 9 years of age are respiratory diseases (29%), injuries (17%) and digestive 

diseases (11%). Children from 10 to 14 years of age are hospitalized for injuries (21%), 

respiratory diseases (17%) and digestive diseases (14%) (CICH, 2000: 102). Finally, male youth 

from 15 to 19 years of age are hospitalized for injuries (29%), digestive diseases (14%) and 

mental disorders (13%). Their female counterparts are hospitalized due to mental disorders 

(16%) and injuries, respiratory diseases and digestive diseases (all 14%) (CICH, 2000: 136). 

 mothers aged 30–34, 35–39, 40–44 or 45 years and older expressed as a percentage of all live births (in a 

given place and time) (Health Canada, 2003a: 22).
5 

1.1.3 Socioeconomic Information and Other Determinants of Health 

Maternal Education 

It is generally accepted that the educational level of the mother has a significant impact on child 

development. Recent research has demonstrated a strong link between maternal education and 

levels of vocabulary development. The more language a child hears, the more the child is likely to 

use. Mothers with higher levels of education are more likely to talk with their children and use a 

broader range of vocabulary (Government of Canada, 2003a). Studies looking at preschool 

vocabulary in relation to reading and math skills 4 years later have suggested that the mother’s 

education level has both a short-term and a long-term impact on the child’s development 

(Government of Canada, 2003a). The effects of maternal education are not confined solely to 

academic skills. They also have an impact on a child’s social skills. Data show that mothers who 

complete more than a secondary school education are less likely to have toddlers with 

problematic personal and social behaviours (Government of Canada, 2003a). 

Maternal education has an impact on children’s exposures to alcohol and tobacco in utero and 

second-hand smoke throughout childhood. There are strong inverse associations between 

maternal education and both smoking and alcohol consumption—i.e., women with lower 

education levels have higher rates of alcohol and tobacco use. Breastfeeding initiation and 

duration rates are also associated with maternal educational levels. Women with fewer years of 

education were less likely to breastfeed than those with higher educational attainment, and, if 

they did breastfeed, they did so for a shorter period of time (Health Canada, 2003a). In 1994–95, 

17.2% of children under the age of 2 years had a mother who had not completed high school, 

compared with 13.4% in 1998–99 (Health Canada, 2003a). 

Proportion of Children Living in Low-Income Families 

Family income is acknowledged as a consistent, significant contributor to child outcomes. For 

example, children who live in low-income families at 4 and 5 years of age are more likely to have 

lower vocabulary skills than their counterparts living in middle- and upper-income families 

(Government of Canada, 2003a). Children living in families with lower incomes are also less likely 

than children in higher-income families to participate in recreational activities, which help build the 

foundation for core skills and success in school (Government of Canada, 2003a). In fact, children 

living in families with lower incomes are more likely to be exposed to multiple environmental 

hazards (Evans and Kantrowitz, 2002). Children living in poor families are more likely to live in 

areas of heavy traffic, to live in substandard housing and to be exposed to second-hand smoke in 

their homes. 

Child poverty rates reflect parental poverty rates and tend to rise or fall as economic conditions 

deteriorate or improve (National Council of Welfare, 2002). Low income cut-offs are used to 

distinguish “low-income” family units from “other” family units. A family unit is considered low 

income when its income is below the cut-off for the size of the family and the community in which 

it lives. Low income cut-offs are set according to the proportion of annual family income spent on 

food, shelter and clothing (Statistics Canada, 1998). In 2001, 15.6% of children in Canada lived in 

families with an income level below the low income cut-off. The percentage of children living in 

low-income family units has been decreasing in Canada in recent years (Statistics Canada, 

2001c). 

Immunization Rate 

Measles immunization rates were selected as an indicator of the availability of public health 

services for children. In Canada, implementation of the two-dose measles immunization program 

in 1996–97 led to a sevenfold decrease in the incidence of reported measles by 1998 (Health 

Canada, 1997). By 2002, 94.5% of 2-year-old children had been immunized against measles 

(Health Canada, 1997). 
6 

MEME MODEL

EXPOSURE INDICATOR 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal 

Proximal 

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

2 Asthma and Respiratory Disease 

2.1 Outdoor Air Pollution 

Indicator 1: Percentage of children living in areas where air pollution 

levels exceed relevant air quality standards

This specific indicator is currently not available in Canada.

Rather, Canada is reporting the following information: 

• Average levels of several air pollutants in Canada, 1984–2002 

• Peak levels of ground-level ozone for selected regions of Canada, 1989–

2002 

• Number of days in 2002 on which ozone levels exceeded the Canada-wide 

Standard 

• Peak levels of fine particulate matter (PM2.5) for selected cities in Canada, 1984–2002 

• Number of days in 2002 on which PM2.5 levels exceeded the Canada-wide Standard 

Issue, Context and Relevance of the Indicator: 

Air pollution, or “smog,” refers to a noxious mixture of air pollutants consisting of ozone, 

particulate matter (PM) and other pollutants referred to as “precursor air pollutants.” Smog can 

often be seen as a haze in the air. Ground-level ozone is not directly emitted into the air, but it is 

formed when nitrogen oxides (NOx) and volatile organic compounds (VOCs) react in sunlight. 

Some PM is released directly to the atmosphere from industrial smokestacks and automobile 

tailpipes, but a large percentage is actually formed in the atmosphere from other pollutants, such 

as sulphur dioxide (SO2), NOx and VOCs. Fossil fuel combustion in motor vehicles, power plants 

and large industries, as well as household activities such as use of wood stoves and fossil fuelpowered lawnmowers, are all sources of air pollution (Environment Canada, 2002a).

Short-term exposures to ambient levels of air pollution have repeatedly been shown to be 

significantly associated with adverse health outcomes in adults, including premature mortality and 

emergency room visits and hospitalizations for cardiorespiratory conditions (Burnett et al., 1994, 

1995, 1997, 1998, 1999; Schouten et al., 1996; Stieb et al., 2002). 

Children are especially sensitive to air pollution because of their rapid growth, developing body 

systems, unique pathways of exposure and higher intakes of air. Air pollution has long been 

considered as a source of exacerbation of asthma and other respiratory conditions; however, 

recent studies suggest that air pollution is associated with infant mortality and the development of 

asthma. Furthermore, PM has been associated with acute bronchitis and pneumonia in children. 

Research has shown that rates of bronchitis and chronic cough are reduced when particulate 

levels decline. There is new evidence that air pollution may also play a role in adverse birth 

outcomes such as early fetal loss, preterm delivery and lower birth weight associated with 

prenatal exposures (Schwartz, 2004). A recent study conducted in Vancouver has found an 

association between relatively low concentrations of gaseous air pollutants and adverse effects 

on birth outcomes, such as low birth weight, preterm birth and intrauterine growth retardation (Liu 

et al., 2003). 

Studies that have investigated the impact of outdoor air pollution on children have noted 

increased coughing and wheezing (Pope, 1991; Segala et al., 1998), increased use of airway 

medications (Roemer et al., 1993; Peters et al., 1997; Van der Zee et al., 1999), increased 

hospital visits for respiratory conditions (Delfino et al., 1997; Burnett et al., 2001) and a 

permanent reduction of lung capacity (Raizenne et al., 1998). The health effects of exposure to 

acidic air pollution were investigated among children 8–12 years of age living in 24 communities 

in the United States and Canada. Results of this study indicated that long-term exposure to acidic 
7 

particles may have harmful effects on lung growth, development and function, with the length of 

exposure being a potential determining factor (Raizenne et al., 1996). Although there have been 

no Canadian studies evaluating the effect of ambient air pollution on mortality in children, a study 

conducted using infant mortality data from selected metropolitan areas in the United States did 

find an association between exposure to particulate matter less than or equal to 10 micrometres 

in diameter (PM10) and several causes of postneonatal mortality, including SIDS (Woodruff et al., 

1997). 

Indicator—Status and Trends: 

Canada was not able to generate this specific indicator. Air quality varies locally as a result of 

local emissions, topography, weather, long-range transport and chemical behaviour of the 

different pollutants; thus, insufficient information was available, on a national scale, to determine 

the spatial dispersion of the various pollutants and link these areas to matching populations. 

Additionally, the suitability of ambient monitoring networks for reporting a population-based 

indicator is currently under review. 

In the interim, Canada is reporting trends in ambient levels of several air pollutants (carbon 

monoxide [CO], VOCs, SO2 and NOx) (see Figure 2.1). It is important to note that national 

average levels of ambient air pollutants are not ideal indicators for communicating the substantial 

variation in air quality across the country and throughout the year. These indicators do not reflect 

the yearly number of poor air quality episodes that are critical for triggering asthma and other 

respiratory disease episodes in children. Canada is reporting peak levels of PM2.5 and groundlevel ozone as well as the number of days in 2002 on which PM2.5 and ground-level ozone levels 

were above the respective Canada-wide Standards (see Figures 2.2–2.5). 

Air quality data are reported as “annual averages” of levels measured in ambient air, which are 

derived by averaging the mean concentrations of air pollutants measured at each monitoring 

station for each year. “Peak levels,” on the other hand, are obtained by averaging the highest 

concentrations measured at each monitoring station for each year. For example, in Canada, 

ground-level ozone levels tend to peak in summer, during mid-afternoon in the city and during 

late afternoon to early evening in rural areas downwind of cities. Both long-term exposure to 

average levels of air pollutants and short-term exposure to peak levels of air pollutants are critical 

for triggering respiratory problems in children. 
8 

Figure 2.1: Average levels of several air pollutants in Canada, 1984–2002

CO

SO2

NOx

VOCs

0

1

2

3

4

5

6

7

8

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002

Year

SO2 (ppb) and CO (ppm) concentrations

0

10

20

30

40

50

60

NOx and VOC (ppb) concentrations

Source: National Air Pollution Surveillance Network, Environment Canada

Notes: 

• Some of these air pollutants are precursor air pollutants that contribute to smog: NOx, SO2 and VOCs. 

• Levels of VOCs, NOx and SO2 are annual averages, whereas CO levels are the 98th percentile of the 

8-hour means for all monitoring stations meeting data completeness requirements. 

• “ppb” are parts per billion and “ppm” are parts per million. 

Key Observations:

• Ambient levels of several important air pollutants have dropped over the last 20 years. 

• The national trends for these pollutants are generally favourable. It should be noted, 

however, that the trends and fluctuations in the levels of these pollutants in local areas 

are masked when national annual averages are presented. 

For more information, see the indicator template in Appendix 3. 
9 

Figure 2.2: Peak levels of ground-level ozone for selected regions of Canada, 

1989–2002

Southern Ontario

Eastern Ontario and 

Quebec

Atlantic provinces Prairies and Northern 

Ontario

British Columbia

0

10

20

30

40

50

60

70

80

90

100

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Year

Concentration (ppb)

Source: National Air Pollution Surveillance Network, Environment Canada 

Notes: The yearly values for each station were calculated by averaging the peaks (i.e., 4th highest 

measurements of the year for 8-hour periods) for the current year and the 2 previous years, resulting in a 3-

year rolling average. The yearly rolling averages for each station were then averaged for each region. 

Key Observations: 

• Although ground-level ozone levels fluctuate from year to year, they did not improve 

significantly in the Prairies, Ontario and Quebec over the period 1989–2002. 

• Ground-level ozone levels have shown improvements in British Columbia and the Atlantic 

provinces. 

• Levels are heavily dependent on the weather, with the highest levels occurring in the 

warmer months.

For more information, see the indicator template in Appendix 3.
10 

Figure 2.3: Number of days in 2002 on which ozone levels exceeded the Canadawide Standard

Source: National Air Pollution Surveillance Network Database, Environment Canada (consulted March 

2004)

Notes: The points represent the number of days on which 8-hour ground-level ozone measurements 

exceeded the Canada-wide Standard of 65 ppb. The standard comes into force in 2010, and achievement 

will be measured using 3 years of data.

Key Observations: 

• In 2002, southern Ontario experienced the highest numbers of days on which groundlevel ozone levels exceeded the Canada-wide Standard. 

• The number of high-ozone days in Canada will fluctuate from year to year. They are 

influenced by topography, local emissions, transported air pollutants and the occurrence 

of hot, stagnant weather conditions. 

• In Canada, ground-level ozone levels tend to peak in summer, during mid-afternoon in 

the city and during late afternoon to early evening in rural areas downwind of cities. 

For more information, see the indicator template in Appendix 3.
11 

Figure 2.4: Peak levels of fine particulate matter (PM2.5) for selected cities in 

Canada, 1984–2002 

0

5

10

15

20

25

30

35

40

45

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002

Year

Concentration (μg/m3)

Source: National Air Pollution Surveillance Network, Environment Canada 

Notes: Peak values are the 98th highest values measured over 24-hour periods at each monitoring station. 

Data in the above graph are collected at 10–15 urban sites across Canada. 

Key Observations: 

• Historical monitoring of fine particulates (PM2.5) in Canada has been limited, and data are 

collected in major urban centres; thus, it has been difficult to determine meaningful 

national trends. 

• The data available from 10–15 sites show a decrease in the peak levels of PM2.5 over the 

first 10 years shown on the figure. However, the last 7 or 8 years did not see 

improvements.

For more information, see the indicator template in Appendix 3. 
12 

Figure 2.5: Number of days in 2002 on which PM2.5 levels exceeded the Canadawide Standard 

Source: National Air Pollution Surveillance Network Database, Environment Canada (consulted March 

2004) 

Notes: The points represent the number of days on which 24-hour PM2.5 measurements exceeded the 

Canada-wide Standard of 30 μg/m3. The standard comes into force in 2010, and achievement will be 

measured using 3 years of data.

Key Observations: 

• Significant increases in real-time monitoring over the last 4 years are improving the 

coverage for PM2.5 monitoring in Canada.

• Southern Ontario experiences the highest number of days with elevated PM2.5, followed 

by the eastern Ontario/southern Quebec region. 

For more information, see the indicator template in Appendix 3. 

Legislative and Policy Framework: 

PM10 and its precursors as well as ozone and its precursors have all been declared toxic under 

Schedule 1 of the Canadian Environmental Protection Act, 1999 (CEPA 1999). In June 2000, the 

federal, provincial and territorial governments (except Quebec) signed the Canada-wide 

Standards for Particulate Matter (PM) and Ozone. These standards commit governments to 

significantly reduce PM and ground-level ozone by 2010. The Canada-wide Standard for PM2.5 is 

30 μg/m3

 averaged over 24 hours using 3 years of data, to be achieved by 2010. The Canadawide Standard for ozone is 65 ppb averaged over 8 hours using 3 years of data, to be achieved 

by 2010. A wide range of actions to reduce emissions from vehicles, products and industry will 

have to be implemented to meet the standards. Some of these, such as vehicle and fuel emission 

standards, will be carried out by the Government of Canada. Other actions, such as emission 
13 

What You Can Do 

For more information on outdoor air quality, visit Clean Air—What You Can Do at: 

http://www2.ec.gc.ca/cleanair-airpur/Individuals-WSFC107749-1_En.htm 

reductions from certain existing industrial sources, will be undertaken by provinces and territories 

(Environment Canada, 2002a, 2002b). 

In 2000, Canada signed the Ozone Annex under the 1991 Canada–U.S. Air Quality Agreement to 

reduce the flow of air pollutants across the Canada–U.S. border. Consequently, the Government 

of Canada announced a commitment of $120 million over 4 years as part of a 10-year program to 

invest in new measures to accelerate action on clean air by focusing on cleaner vehicles and 

fuels, initial measures to reduce smog-causing emissions from industrial sectors, improvements 

to the cross-country network of air pollution monitoring stations and expansion of the public 

reporting on pollutant releases by industry (Environment Canada, 2003a). 

Research and its translation into policy are critical components of health protection measures for 

air pollution. Health and air quality research contributes to a better understanding of the relative 

risks of vulnerable subpopulations to enable policymakers to develop more equitable policy 

outcomes for Canadians. Health Canada conducts specialized, multidisciplinary research to 

assess the health impacts of exposure to air pollution. This ongoing research supports and 

improves the health-based risk assessments and subsequent management activities, such as 

development of air quality objectives and standards. Health Canada’s epidemiological research 

on PM and ozone has contributed to a host of federal regulatory and standards-based activities. 

Currently, under the Canada–U.S. Border Air Quality Strategy, Health Canada is preparing to 

undertake a cross-sectional study using a questionnaire survey and objective measures of lung 

function. This will identify any associations between respiratory symptoms and air pollution in 

elementary school children living in Windsor. These children may be followed up next fiscal year 

to investigate any changes in their respiratory health (symptoms and lung function) (Health 

Canada, 2004a).

Opportunities for Improvement:

A review of ambient air pollution monitoring networks to assess their suitability in estimating 

population exposure, in addition to further research in determining spatial dispersion of the 

various air pollutants across Canada, will help Canada report this indicator in the future. In 

addition, it would be useful to develop reference levels that would consider children’s 

vulnerabilities to air pollutants. Current ambient levels of air pollutants could then be reported 

against those health-based reference levels. 

Indicators could also be developed to reflect the health effects associated with short-term 

exposure to high levels of certain air pollutants—for example, the peak level of ground-level 

ozone within a day. The Government of Canada has committed to building on the 2003 

recommendations of the Environment and Sustainable Development Indicators Initiative of the 

National Round Table on the Environment and the Economy by developing and reporting 

annually on new air quality indicators. 
14 

MEME MODEL

EXPOSURE INDICATOR 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal 

Proximal 

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

2.2 Indoor Air Pollution 

Indicator 2: Measure of children exposed to second-hand smoke 

Issue, Context and Relevance of the Indicator: 

In terms of population health, much emphasis has been placed on the health 

impacts of exposures to ambient air pollution. Given that the Canadian 

Human Activities Pattern Survey indicates that persons in Canada spend 

about 90% of their time indoors (in built environments such as homes, 

offices, factories and schools), the implications of indoor air quality for public 

health are demonstrable (Leech et al., 1996). The importance of indoor air 

quality to human health is highlighted in reports such as Respiratory Disease 

in Canada 2001 (Canadian Institute for Health Information et al., 2001) and 

The Prevention and Management of Asthma in Canada (Health Canada, 

2000). Both reports indicate the rising rate of respiratory health problems and 

the possible involvement of indoor air pollutants. 

Indoor air quality is influenced by outdoor air pollution, combustion appliances, personal sources 

(second-hand smoke, pets), consumer products and the building fabric. The current course of 

improved residential energy efficiency may be having direct adverse effects on the quality of 

indoor air. Airtight buildings, combined with reduced ventilation, can result in the concentration of 

many of these contaminants in the built environment and can increase the health risks. In 

addition, as multiple concomitant exposures may heighten sensitivities, a combination effect is 

important to consider. 

Children are especially sensitive to their environments, because of rapid growth, developing body 

systems, unique pathways of exposure and higher daily intakes of air, water and food per unit 

body weight. The National Academy of Sciences in the United States recently reviewed the 

evidence for the development of asthma in children and concluded that there is substantial 

evidence of a causal relationship between exposure to house dust mites and asthma (National 

Academy of Sciences, 2000). Exposures to second-hand smoke (preschool children), cat and 

dog allergens, cockroaches, dust mites, nitrogen dioxide (NO2) or NOx (high-level exposures), 

fungi and rhinoviruses have been shown to be related to the development and exacerbation of 

asthma. Indoor air quality may also influence other respiratory diseases, such as chronic 

obstructive pulmonary disease (COPD). Much less research has been done on these diseases in 

comparison with asthma. 

Children who are exposed to second-hand smoke are at increased risk of serious adverse health 

effects, including bronchitis, pneumonia, lower respiratory tract infections, chronic/repeated ear 

infections and SIDS (Health Canada, 2002). Second-hand smoke is one of the irritants known to 

trigger asthma attacks. Several recent reviews concluded that there is sufficient evidence of a 

causal association between childhood incident asthma (the development of asthma) and 

postnatal second-hand smoke exposure (World Health Organization, 1999; Jaakkola and 

Jaakkola, 2002; DiFranza et al., 2004; California Environmental Protection Agency, 2004). 

Indicator—Status and Trends: 

The data for this indicator, the percentage of children exposed to second-hand smoke in 

Canadian homes (Figure 2.6), were obtained from the Canadian Tobacco Use Monitoring Survey 

(CTUMS) Report and the National Population Health Survey (NPHS). 
15 

Figure 2.6: Percentage of children exposed to second-hand smoke in Canadian 

homes, by age group, 1999–2002

Age 0–5

Age 6–11

Age 12–14

Age 15–19

0

5

10

15

20

25

30

35

40

1999 2000 2001 2002

Year

% of children

Source: Canadian Tobacco Use Monitoring Survey, Household Component

Key Observations: 

• Generally, the percentages of children (in all four age categories 0–5, 6–11, 12–14 and 

15–19) exposed to second-hand smoke in Canadian homes are decreasing. 

• It is also evident that for all 4 years (1999–2002), exposure to second-hand smoke is 

highest among children aged 15–19 and lowest among those aged 0–5. 

• Overall, in 2002, 19% of children aged 0–17 were regularly exposed to second-hand 

smoke in the home.

For more information, see the indicator template in Appendix 3. 

Legislative and Policy Framework: 

One of the primary goals of the Tobacco Control Program, under the federal Tobacco Control 

Strategy, is to reduce involuntary exposure of all Canadians, including children, to second-hand 

smoke. To achieve this goal, a comprehensive approach is employed, which includes resource 

development that encourages and supports the development of municipal by-laws for smoke-free 

public areas; mass media campaigns directed at youth and adults to raise awareness of the 

dangers of exposure to second-hand smoke; research on attitudes and behaviours relating to 

second-hand smoke; and surveillance on exposure to second-hand smoke in the home and 

workplace. 

The Indoor Environments Division of the Safe Environments Programme of Health Canada, 

whose mission is to provide leadership in the development of national collaborative strategies to 

promote and enhance healthy indoor environments in Canada, has developed a “Tools for 
16 

Schools” Action Kit. The purpose of the kit is to provide basic information and easy-to-follow 

actions to address indoor air quality in schools. 

Opportunities for Improvement:

Children may be exposed to second-hand smoke in their homes and other public places as well. 

Biomonitoring, or biological monitoring, is the measurement of the concentration of a chemical in 

human specimens such as blood, urine, saliva or adipose tissue. Measures of cotinine, a 

metabolite of nicotine, in urine would provide a more accurate measure of all sources of exposure 

to second-hand smoke. 

What You Can Do 

For more information on second-hand smoke, consult Second-hand Smoke: The Facts at: 

http://www.hc-sc.gc.ca/hl-vs/tobac-tabac/second/do-faire/ribbon-ruban/index_e.html 
17 

MEME MODEL

HEALTH OUTCOME INDICATOR 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal 

Proximal 

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

2.3 Asthma 

Indicator 3: Prevalence of asthma in children 

Issue, Context and Relevance of the Indicator: 

Asthma is one of the most prevalent chronic conditions in Canadian children 

and is also a serious problem in adults. According to the NPHS, it affects 2.5 

million people—8% of adults and 12% of children (Statistics Canada, 2000).

Asthma reduces the quality of life for individuals with asthma and their 

families and imposes a heavy burden on the nation’s health care 

expenditures. The exact cause of asthma is unknown, but it appears to be 

the result of a complex interaction of three factors: 

1) predisposing factors (e.g., atopy—a tendency to have an allergic reaction 

to foreign substances); 

2) environmental causal factors (especially second-hand smoke, house dust 

mite antigen, outdoor air pollution); and 

3) aggravating factors that increase the frequency and/or severity of asthma episodes, including 

second-hand smoke, certain indoor air allergens, outdoor air pollutants including PM and 

ozone, and respiratory infections (Health Canada, 2004a). 

While asthma is often considered a “children’s disease,” it is common among all age groups of 

Canadians. Children and youth do have the highest prevalence of asthma and the highest 

hospitalization rates. The prevalence of asthma among adults is increasing and is cause for 

concern. Further research is needed to identify the potential factors responsible for increased 

prevalence rates, as well as to study the primary prevention of asthma in at-risk individuals. 

Reducing exposure to airborne school and workplace contaminants, second-hand smoke, house 

dust mites, animal dander and moulds may decrease the risk of the development of asthma 

among sensitive individuals and should decrease symptoms and attacks among those with 

asthma. While individuals can take personal responsibility for some preventive measures, other 

solutions require the collaborative efforts of government, industry and business sectors. 

Legislation, policies and voluntary cooperation need to be part of a concerted effort to decrease 

school and workplace contaminants and improve air quality (Health Canada, 2000). 

Indicator—Status and Trends: 

Three Canadian population-based surveys asked parents if their child(ren) had ever been 

diagnosed with asthma by a physician. These surveys constitute the source of information on 

asthma prevalence in Canada. The surveys provide data on the percentage of children who have 

reported a diagnosis of asthma. Since it is difficult to differentiate in the surveys those with other 

respiratory conditions (such as wheezing) from those with asthma, children under the age of 4 

were excluded from the analyses. “Prevalence” is the number of people in the population who 

have a condition at a specific point in time. “Incidence” is the number of new people who develop 

the condition during a specific time period. Each measure provides valuable information on the 

population. Canada does not currently have incidence data on asthma, so we must rely on 

prevalence data (Figure 2.7). 
18 

Figure 2.7: Prevalence of physician-diagnosed asthma (ever) among children, by 

sex and age group, Canada, 1994–95, 1996–97 and 1998–99 

Girls 4–7

Boys 4–7

Girls 8–11

Boys 8–11

0

5

10

15

20

25

1994–95 1996–97 1998–99

Year

Prevalence of asthma (%)

Source: Centre for Chronic Disease Prevention and Control, Health Canada, using data adapted from the 

National Longitudinal Survey of Children and Youth (cross-sectional component), Statistics Canada, 1994–

95, 1996–97 and 1998–99 

Key Observations: 

• Since 1994, asthma prevalence has been increasing among children (except for boys 

aged 4–7 years). 

• Boys of all ages have a higher prevalence of asthma than girls. 

• Currently, approximately 20% of boys aged 8–11 have been diagnosed with asthma, the 

highest prevalence group among children. 

For more information, see the indicator template in Appendix 3. 

Legislative and Policy Framework: 

Canada is currently reviewing and developing national guidelines for the prevention and 

management of asthma among children. They are being developed by the Canadian Network on 

Asthma Care and will be national. The organizations involved are the Canadian Paediatric 

Society, the Canadian Thoracic Society, the College of Family Physicians, the Canadian 

Respiratory Therapy Society, Asthma Educators, the Asthma Society of Canada and the 

Canadian Lung Association. The new pediatric clinical practice guidelines will include 

recommendations on how to diagnose asthma. They will include the need to take a history of 

symptoms as well as a family history and a history of allergy or atopy, as this predisposes the 

wheezing child to actually have persistent wheezing and asthma. 
19 

Opportunities for Improvement: 

Data collected in these population health surveys are self-reported; thus, validity and reliability of 

data could be questionable. Information on patient encounters with the health care system may 

provide a more accurate method of assessing asthma prevalence. 
20 

MEME MODEL

EXPOSURE INDICATOR 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal

Proximal

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

Umbilical cord blood lead levels and source assessment among 

the Inuit in northern Quebec 

A study on Inuit newborns from northern Quebec showed that about 

7% of 475 Inuit newborns had a cord blood lead concentration equal to 

or greater than 0.48 micromoles per litre, an intervention level adopted 

by many governmental agencies. A comparison between the cord 

blood lead isotope ratios of Inuit and southern Quebec newborns 

showed that lead sources for these populations were different. The 

study suggests that lead shot used for game hunting was an important 

source of lead exposure in the Inuit population. A cohort study 

conducted in three Inuit communities shows a significant decrease of 

cord blood lead concentrations after a public health intervention to 

reduce the use of lead shot. Lead shot ammunition can be a major and 

preventable source of human exposure to lead. 

Source: Lévesque et al. (2003)

3 Lead and Other Chemicals, Including Pesticides 

3.1 Blood Lead Levels 

Indicator 4: Blood lead levels in children

This information is currently not available in Canada. 

Blood lead levels provide a measure of a child’s current body burden 

of lead. There is no recent, nationally representative survey of blood 

lead levels in children in Canada. For this indicator, Canada is 

presenting a case study on blood lead levels in children in Ontario. 

Issue, Context and Relevance of the Indicator: 

It is generally well recognized that low-level or moderate lead 

exposure during early childhood can cause persistent adverse 

neurobehavioural effects, including cognitive deficits. The child and 

developing fetus are at greater risk for higher blood lead levels than 

adults, for a number of reasons. Because children are developing rapidly, they have a higher 

metabolic rate. As a result, they take in more air, food and water per unit body weight per day. 

They are also more efficient than adults at absorbing certain substances such as lead. It has 

been estimated that adults absorb 10–15% of lead ingested with meals, but children and 

pregnant women can absorb up 

to 50% (Wigle, 2003: 75). In 

addition, their hand-to-mouth 

behaviour places young 

children at risk of increased 

exposure to lead-contaminated 

soil and house dust. 

Compounding this, the 

developmental organs and 

systems of children are 

immature, making them less 

able to inactivate and/or 

eliminate certain toxicants. 

There is no known “safe” blood 

lead level for children, but risks 

of adverse health impact 

decline as exposure to lead declines. Studies suggest that children are most susceptible to the 

neurological effects of lead in the first 3 years of life because of the brain development that takes 

place during this time (Wigle, 2003). 

Sources of environmental lead exposure include lead-based paint; soil and dust from paint, 

gasoline and industrial sources; drinking water; certain occupations and hobbies; airborne lead 

from point sources such as lead smelters; and lead-contaminated food (from sources such as 

lead-soldered cans, the rain and soil in which food plants are grown, storage and serving 

vessels), dust in the home and consumer products (Health Canada, 2004d). The case study

presented illustrates the fact that lead in gasoline was an important contributor to children’s 

exposure to lead. Lead exposure in Canada has decreased substantially, mainly because leaded 

gasoline and lead-based paint were phased out and the use of lead solder in food cans was 

virtually eliminated (Health Canada, 2004d). 
21 

CASE STUDY 

Blood lead levels in children in Ontario 

There has been some sampling of blood lead levels in certain regions of Canada. Since 1980, health 

departments in Ontario have conducted several blood lead screening surveys in children living in several 

cities and regions of the province. The same collection procedure (capillary finger-prick blood samples) and 

method for blood lead analysis (Zeeman graphite furnace atomic absorption spectrophotometry) were used 

in all the blood lead analyses in this study. 

As illustrated in Figure 3.1, the findings from this analysis indicate that as lead levels in gasoline declined, so 

did children’s blood lead levels in Ontario. These findings have been confirmed by evidence from the United 

States, where a biomonitoring system for measuring blood lead levels has been in place since the 1970s, 

through the U.S. National Health and Nutrition Examination Survey. 

Figure 3.1: Decline in the geometric mean blood lead concentrations related to a 

decline in consumption of leaded gasoline, in Ontario, Canada, 1983–1992 

0

2

4

6

8

10

12

14

16

18

1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992

Year

Blood lead level (μg/dL)

0

250

500

750

1000

1250

1500

1750

2000

2250

2500

2750

3000

Total lead (million g/year)

Toronto Eastern Health Unit

Toronto Western Health Unit

City of Toronto

Other Ontario regions

Total lead

Source: Adapted from Wang et al. (1997) 

Legislative and Policy Framework: 

The use and release of lead and its compounds fall under various laws, regulations, agreements 

and voluntary initiatives designed to protect the environment and human health. Control 

measures range from maximal government intervention (e.g., prohibition of lead in gasoline) 

through restrictions (e.g., permitted levels in consumer products) and voluntary measures (e.g., 

industry agreement to eliminate lead-soldered cans) to consumer awareness and education 

programs. 

Environment Canada is working with other countries to reduce emissions of heavy metals, 

including lead, that are subject to long-range atmospheric transport. 
22 

Health Canada has promoted awareness of issues concerning lead and health by educating the 

public, health professionals and industry. Health Canada, in partnership with various groups, has 

released many publications on topics such as lead and home renovations and lead risk 

associated with arts and crafts. Other non-regulatory initiatives include the Guidelines for 

Canadian Drinking Water Quality and standards under the national Plumbing Code for plumbing 

fixtures that come into contact with potable water. 

What You Can Do 

For more information on lead and human health, consult: 

http://www.hc-sc.gc.ca/ewh-semt/contaminants/lead-plomb/asked_questionsquestions_posees_e.html

Opportunities for Improvement: 

The collection of nationally representative data on blood lead levels in children would assist in 

identifying the scope of this issue in Canada. Blood lead level sampling is usually reported by 

percentiles, identifying the distribution of blood lead levels in the population selected (see, for 

example, the indicator on blood lead levels provided in the United States indicators report; U.S. 

EPA, 2005). As such, national data on blood lead levels would allow the identification of 

subpopulations of children in Canada that may be at risk from high exposure to lead (higher 

percentiles in the population). 
23 

MEME MODEL

EXPOSURE INDICATOR 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal

Proximal

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

3.2 Lead in the Home 

Indicator 5: Children living in homes with a potential source of lead 

Issue, Context and Relevance of the Indicator: 

Dust in the home and soil can be significant sources of lead 

exposure, especially for young children. Lead dust can be generated 

within the home, especially older homes (pre-1960) that used leadbased paints; such homes may also have lead pipes that can leach 

lead into drinking water. Lead dust is especially dangerous for 

babies and young children who crawl on the floor, because their 

breathing zone is closer to floor level, which increases their exposure 

to lead dust. The key pathway of childhood exposure to lead in 

residential environments is ingestion of house dust by toddlers and 

preschoolers through normal hand-to-mouth activities. 

It has been estimated that 97% of children’s total daily lead intake is from ingestion of house dust, 

food and water, and only a small proportion (<3%) is through inhalation (Davies et al., 1990). 

Another study concluded that 50% of the daily lead intake of 2-year-old urban children occurs by 

ingestion of house dust through normal hand-to-mouth activities (Thornton et al., 1994). Older 

homes are more likely to contain lead in house dust from paint. Most indoor and outdoor paints 

produced before 1960 contained substantial amounts of lead. Although older homes are more 

likely to contain lead in house dust from paint, lead-based paint that is in good condition is 

believed not to pose a risk to residents living in the home. The highest risk of exposure to lead 

may be to children living in an older home during a renovation where paint is sanded, burned with 

a propane torch or scraped off, as these activities increase the amount of lead in house dust 

(Laxen et al., 1988; Davies et al., 1990; Rasmussen et al., 2001; Rasmussen, 2004). Children 

may also be at risk if they chew on surfaces painted with lead-based paint. Biomonitoring surveys 

in the United States have revealed that children living in older homes are more likely to 

experience elevated blood lead levels. Children living in low-income families are particularly at 

risk (U.S. Centers for Disease Control and Prevention, 1997). 

Indicator—Status and Trends: 

This indicator represents the proportion of children 19 years of age or younger living in housing 

stock built before 1960 in the Census years 1991, 1996 and 2001 (Figure 3.2). 
24 

Figure 3.2: Percentage of children living in pre-1960 homes, by age group, 

Canada, 1991, 1996 and 2001 

0

5

10

15

20

25

30

0–4 years 5–9 years 10–14 years 15–19 years

Age Groups

% of children

1991

1996

2001

Source: Statistics Canada, Census of Population, 1991, 1996, 2001

Key Observations: 

• In 2001, 24% of Canadian children under 5 years of age lived in housing built prior to 

1960. 

• The number of children in the four age categories (<5, 5–9, 10–14 and 15–19) living in 

homes built prior to 1960 declined slightly between 1991 and 2001.

• This indicator measures only the potential for exposure to lead in home. The slow 

retirement of old housing stock may contribute to the decline observed. 

 

For more information, see the indicator template in Appendix 3. 

Legislation and Policy Framework: 

In Canada, the Liquid Coating Materials Regulations were enacted under the Hazardous 

Products Act in 1976 to restrict the lead content in paints and other liquid coatings on furniture, 

household products, children’s products, and exterior and interior surfaces of any building 

frequented by children to 0.5% by weight. By the end of 2002, the amount of lead in paint was 

restricted to 0.06% by weight. Although the lead content of exterior paint is not regulated, 

Canadian paint manufacturers have voluntarily ensured that no lead is intentionally added. 

Exterior paint with lead carries a warning label not to use it inside. Homes built before 1960 were 

likely painted with lead-based paint. Some paint made in the 1940s contained up to 50% lead by 

dry weight. During the 1950s, the use of lead in exterior paint was more common, but lead paint 

was still used in the interior of homes. 

What You Can Do 

The Canadian Mortgage and Housing Corporation provides guidelines on issues to examine 

when considering a renovation on an older home, how to test for leaded paints and precautions to 

take when dealing with leaded paint. 

For more information, see Lead Precautionary Measures at: 
25 

http://www.cmhc-schl.gc.ca/publications/en/rh-pr/tech/92-206.pdf 

Opportunities for Improvement: 

Information on the effectiveness of measures to reduce the release of lead into house dust during 

a renovation would assist in reducing children’s risks of exposure to elevated levels of lead. 

Measures of blood lead levels of children living in older homes, particularly children of low-income 

families, would assist in determining if the American pattern of elevated blood lead levels 

associated with older housing units occurs in Canadian children. 
26 

MEME MODEL

ACTION INDICATOR 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal 

Proximal 

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

3.3 Industrial Releases of Lead and Selected Chemicals 

Indicator 6: PRTR data on industrial releases of lead 

Indicator 7: PRTR data on industrial releases of 153 chemicals 

Issue, Context and Relevance of the Indicators: 

The indicators use pollutant release and transfer register (PRTR) data as 

“action” indicators. An action indicator under the MEME model is intended to 

describe preventive or remedial action taken by governments to address a 

specific environmental threat to children’s health. The PRTR data indicators 

are intended to measure effectiveness at reducing emissions of toxic 

substances to the environment. 

The PRTR data are annual estimates of emissions to the environment. For 

chemicals that persist a long time in the environment, bioaccumulate and 

travel far from their points of origin, these ongoing annual releases are of 

particular concern, because they add to the cumulative load of chemicals to 

the environment. 

PRTR data are just one source of information on toxic chemicals in the environment. Other 

sources include measurements of concentrations of chemicals in the air, land and water in our 

communities, specialized chemical and air pollutant inventories, hazardous waste databases, 

modelling estimates, body burdens in plants, fish and people, and industrial emission rates for 

chemicals. Canada is also reporting total atmospheric releases of mercury in Canada (see Figure 

3.14). 

In making good use of PRTR data, it is important to know their limitations. PRTR data do not 

include: 

• all potentially harmful chemicals—just those on the lists of chemicals to be reported; 

• chemicals released from mobile sources, such as cars and trucks; 

• chemicals released from natural sources, such as forest fires and erosion; 

• chemicals released from small sources, such as dry cleaners and gas stations; 

• chemicals released from small manufacturing facilities with fewer than 10 employees; 

• chemicals released from consumer products; 

• information on the toxicity or potential health effects of chemicals; 

• information on risks from chemicals released or transferred; or 

• information on exposures of humans or the environment to chemicals released or transferred. 

From a children’s health perspective, the rationale for providing action indicators of PRTR data is 

that industrial emissions of these chemicals may contribute to the contamination of the food 

children eat, the water they drink, the air they breathe and the soil with which they come in 

contact. In addition, certain subpopulations of children may be exposed to pollutants released to 

air, water and soil in their community. PRTR data represent estimated releases of pollutants to 

the environment and do not represent estimates of human exposure to these substances. The 

degree of human exposure is not necessarily proportional to the number of tonnes of pollutants 

released. There are many factors to consider in determining human exposure to each chemical 

and the risks associated with that exposure. These include: 

• the routes of exposure (ingestion, inhalation, dermal); 

• the duration and frequency of the exposure; 

• the rate of uptake of the substance; 

• the individual age and gender; and 
27 

• the disease, overall health and nutritional status of the individual (including pregnancy status, 

in the case of prenatal exposure). 

PRTR data for Canada are provided by the National Pollutant Release Inventory (NPRI), which is 

a legislated, nationwide, publicly accessible inventory of pollutants released to the environment. It 

was created in 1992 to provide Canadians with information on pollutant releases to air, water and 

land from facilities located in their communities and the quantities sent to other facilities for 

disposal, treatment or recycling. For the 2001 reporting year, there were 274 substances listed in 

the NPRI. 

Indicators—Status and Trends: 

Canada is reporting pollutant releases for lead and its compounds, based on matched industrial 

sectors with the United States (Figure 3.3), and total estimated emissions of lead to air (Figure 

3.4). Canada is also reporting pollutant releases for 153 “matched” chemicals—those chemicals 

reported in the NPRI that are also required to be reported in the United States. Figures 3.3 and 

3.5 present on-site and off-site releases, in tonnes, describe where in the environment the 

chemicals were released and provide the number of facilities reporting releases for each year. 

Figure 3.6 presents total on-site and off-site releases for 153 matched chemicals, in tonnes, by 

sector, for the period 1998–2002. 

Figure 3.3: On- and off-site releases of lead (and its compounds), Canada, 1995–

2000 

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

1995 1996 1997 1998 1999 2000

Year

Releases (tonnes)

0

20

40

60

80

100

120

140

160

Number of reporting facilities

On-site air

On-site water

On-site

underground

injection

On-site land

Off-site

releases

Number of

facilities

Source: National Pollution Release Inventory (NPRI), Environment Canada 

Notes: 

• On-site air emissions include stack or point releases, storage or handling releases, fugitive releases, 

spills and other non-point releases. 

• On-site water discharges include direct discharges, spills and leaks; on-site releases to land include 

landfill, land treatment, spills, leaks and other. 

• Off-site transfers include transfers for disposal and treatment, but not recycling. 

• Only certain manufacturing industries were selected, not including electric utilities, hazardous waste 

facilities or mining facilities. 
28 

Key Observations: 

• Overall, while the number of reporting facilities increased by 10% between 1995 and 

2000, total releases of lead and its compounds decreased by 46%. Releases increased 

moderately from 1995 to 1997, followed by a decrease in total releases from 1998 to 

2000. 

• Off-site releases (primarily transfers to landfills) accounted for the largest portion of 

releases and variation over this time period. 

• On-site land releases decreased by 70% from 1995 to 2000. 

• On-site releases to the air decreased from 1996 to 1999 but showed an increase (of 

0.6%) from 1999 to 2000. 

For more information, see the indicator template in Appendix 3. 

Figure 3.4: Total estimated emissions of lead to air, Canada, 1990–2002 

0

400

800

1200

1600

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Year

Emissions (tonnes)

Source: Lead emissions inventory, Criteria Air Contaminants Office, Environment Canada 

Key Observations: 

• With the introduction of unleaded gasoline in Canada in 1975, lead concentrations in the 

air have declined significantly. Leaded gasoline in cars was banned in Canada in 1990 

(Health Canada, 2004b). 

• Total estimated lead emissions to air (including those reported to the NPRI) decreased by 

67% between 1994 and 2002. 

For more information, see the indicator template in Appendix 3. 
29 

Figure 3.5: Total on- and off-site releases of matched chemicals, Canada, 1998–

2002

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

200000

1998 1999 2000 2001 2002

Year

0

500

1000

1500

2000

2500

On-site air

On-site water

On-site

underground

Injection

On-site land

Off-site

releases

Number of

facilities

Releases (tonnes)

Number of Reporting Facilities

Source: National Pollutant Release Inventory, Environment Canada 

Notes: 

• On-site air emissions include stack or point releases, storage or handling releases, fugitive releases, 

spills and other non-point releases. 

• On-site water discharges include direct discharges, spills and leaks; on-site releases to land include 

landfill, land treatment, spills, leaks and other. 

• Off-site transfers include transfers for disposal and treatment, but not recycling. 

• The 153 matched chemicals are the chemicals reported in both the Canadian NPRI and the U.S. 

Toxics Release Inventory. 

• Not all industry sectors are included to ensure consistent reporting between Canada and the United 

States. 

Key Observations: 

• The number of facilities reporting to the NPRI for the matched chemicals set increased by 

41% between 1998 and 2002, while total releases decreased by 11% during this period. 

Releases to on-site air and water increased between 1998 and 2002, while releases to 

on-site underground injection and off-site transfers (primarily transfers to landfills) 

decreased, and on-site land releases were about the same in 1998 and 2002. 

For more information, see the indicator template in Appendix 3. 
30 

Figure 3.6: Total on- and off-site releases of matched chemicals, by industry 

sector, Canada, 1998–2002 

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

1998 1999 2000 2001 2002

Year

All others

Primary metals

Tonnes

Paper products

Electric utilities

Chemicals

Source: National Pollutant Release Inventory, Environment Canada 

Notes: 

• Total on- and off-site releases include on-site air emissions, on-site water discharges, on-site 

releases to land and off-site transfers. 

• The 153 matched chemicals are the chemicals reported in both the Canadian NPRI and the U.S. 

Toxics Release Inventory. 

• Not all industry sectors are included to ensure consistent reporting between Canada and the United 

States. 

Key Observations: 

• Of the four industry sectors with the largest total releases in 1998, the primary metals 

and chemical manufacturing sectors reported reductions in releases of the matched set 

of chemicals of 33% and 36%, respectively, between 1998 and 2002, while the paper 

products and electric utilities sectors both reported increases, of 26% and 4%, 

respectively, over the same period 

For more information, see the indicator template in Appendix 3. 

In addition to reporting the total releases for lead and the 153 matched chemicals, Canada is 

reporting separately emissions of a few substances selected because they are known to have 

adverse effects on children’s health. The seven substances selected are not intended to be a 

comprehensive list of substances that are of specific concern to children’s health. Rather, they 

are a few substances for which there are known adverse health effects in childhood or adulthood 

associated with prenatal or childhood exposure. The selected substances are arsenic (Figure 

3.7), benzene (Figure 3.8), cadmium (Figure 3.9), chromium (Figure 3.10), dioxins and furans 

(Figure 3.11), hexachlorobenzene (HCB) (Figure 3.12) and mercury (Figures 3.13 and 3.14). This 

is Canada’s first attempt at prioritizing a vast amount of data from a children’s health perspective. 
31 

Figure 3.7: On-site releases to air, water and soil of arsenic and its compounds 

reported in the NPRI for Canada, 1994–2002 

0

100

200

300

1994 1995 1996 1997 1998 1999 2000 2001 2002

Year

On-site releases (tonnes)

0

50

100

150

200

250

Number of facilities

Releases

Facilities

New reporting

threshold

Source: National Pollutant Release Inventory, Environment Canada 

Notes: On-site releases to air include stack and point emissions; releases to water include water 

discharges; and releases to land include fill and treatment. These numbers do not include spills, leaks and 

fugitive emissions, nor do they include underground injection or off-site transfers for recycling or disposal. 

Key Observations: 

• Since 1994, on-site releases of arsenic to air, water and soil have increased slightly, by 

11.4%, from 180 tonnes in 1994 to 201 tonnes in 2002. 

• Some important changes to NPRI reporting guidelines with respect to arsenic releases 

occurred in 2000 and 2002. In the year 2000, the 20 000-hour employee threshold was 

removed for certain industries, including wood preservation, a source of arsenic releases. 

In 2002, the reporting threshold for arsenic was decreased from 10 tonnes to 50 kg at 

0.1% concentration. 

• Much of the increase in on-site releases of arsenic, which include emissions to air and 

releases to land and water, can be accounted for by the almost fivefold increase in the 

number of reporting facilities. 
32 

Figure 3.8: On-site releases to air, water and soil of benzene reported in the NPRI 

for Canada, 1994–2002 

0

1000

2000

3000

1994 1995 1996 1997 1998 1999 2000 2001 2002

Year

On-site releases (tonnes)

0

50

100

150

200

250

Number of facilities

Releases

Facilities

Source: National Pollutant Release Inventory, Environment Canada 

Notes: On-site releases to air include stack and point emissions; releases to water include water 

discharges; and releases to land include fill and treatment. These numbers do not include spills, leaks and 

fugitive emissions, nor do they include underground injection or off-site transfers for recycling or disposal. 

Key Observations:

• In 1994, 2608 tonnes of benzene were released, while in 2002, 863 tonnes were 

released—representing a 67% decrease in benzene releases. 

• These have been significant decreases in on-site releases since 1994, while the number 

of reporting facilities has been steadily increasing. 
33 

Figure 3.9: On-site releases to air, water and soil of cadmium and its compounds 

reported in the NPRI for Canada, 1994–2002 

0

25

50

75

100

1994 1995 1996 1997 1998 1999 2000 2001 2002

Year

On-site releases (tonnes)

0

50

100

150

200

250

300

Number of facilities

Releases

Facilities

New reporting

threshold

Source: National Pollutant Release Inventory, Environment Canada 

Notes: On-site releases to air include stack and point emissions; releases to water include water 

discharges; and releases to land include fill and treatment. These numbers do not include spills, leaks and 

fugitive emissions, nor do they include underground injection or off-site transfers for recycling or disposal. 

Key Observations:

• In 1994, cadmium releases were 82 tonnes, while in 2002, releases were down to 40 

tonnes. 

• The number of reporting facilities increased steadily from 20 reporting facilities in 1994 to 

46 in 2001. 

• In 2002, the reporting threshold for cadmium was reduced from 10 tonnes to 5 kg with a 

0.1% concentration criterion, increasing the number of reporting facilities to 281. 
34 

Figure 3.10: On-site releases to air, water and soil of chromium and its 

compounds reported in the NPRI for Canada, 1994–2002 

0

500

1000

1500

2000

1994 1995 1996 1997 1998 1999 2000 2001 2002

Year

On-site releases (tonnes)

0

100

200

300

400

500

Number of facilities

Releases

Facilities

Source: National Pollutant Release Inventory, Environment Canada

Notes: On-site releases to air include stack and point emissions; releases to water include water 

discharges; and releases to land include fill and treatment. These numbers do not include spills, leaks and 

fugitive emissions, nor do they include underground injection or off-site transfers for recycling or disposal. 

Key Observations: 

• On-site chromium releases remained at a steady level between the years 1994 and 1996 

(65 tonnes and 69 tonnes, respectively) and then exhibited a drastic increase beginning 

in 1997 and ending in 1999 (790 tonnes and 1048 tonnes, respectively). 

• Emissions of chromium hit a peak of 1740 tonnes in 1998, only to drop again to 161 

tonnes in 2000. The peak in 1998 was caused by a single nickel, copper and ore mining 

facility with a one-time release of 1545 tonnes (approximately 89% of total on-site 

releases) to land. 

• Beginning in 2002, the reporting of hexavalent chromium, the most toxic of chromium 

compounds, was done separately. 
35 

Figure 3.11: On-site releases to air, water and soil of dioxins and furans reported 

in the NPRI for Canada, 2000–2002 

0

25

50

75

100

125

2000 2001 2002

Year

On-site releases (g TEQ)

0

100

200

300

400

Number of facilities

Releases

Facilities

Source: National Pollutant Release Inventory, Environment Canada

Notes: On-site releases to air include stack and point emissions; releases to water include water 

discharges; and releases to land include fill and treatment. These numbers do not include spills, leaks and 

fugitive emissions, nor do they include underground injection or off-site transfers for recycling or disposal. 

TEQ = Toxic equivalency. The TEQ is obtained by multiplying the concentration of each congener by its 

relative toxicity factor. 

Key Observations: 

• Between 2000 and 2002, releases decreased from 109.5 g TEQ to 92.5 g TEQ, while the 

number of reporting facilities increased from 300 to 345, respectively. 

• Metal producers do not have a quantitative threshold for reporting—all facilities that use 

or engage in activities that have the potential to incidentally manufacture dioxins and 

furans must submit an NPRI report. 

• In 2002, the sectors emitting the greatest quantities of dioxins and furans were primary 

metal manufacturing, electricity generation and waste management. 
36 

Figure 3.12: On-site releases to air, water and soil of hexachlorobenzene reported 

in the NPRI for Canada, 2000–2002 

0

0.01

0.02

0.03

0.04

0.05

2000 2001 2002

Year

On-site releases (tonnes)

0

100

200

300

400

Number of facilities

Releases

Facilities

Source: National Pollutant Release Inventory, Environment Canada

Notes: On-site releases to air include stack and point emissions; releases to water include water 

discharges; and releases to land include fill and treatment. These numbers do not include spills, leaks and 

fugitive emissions, nor do they include underground injection or off-site transfers for recycling or disposal.

Key Observations: 

• Between 2000 and 2002, total releases of HCB increased from 0.037 tonnes to 0.045 

tonnes and the number of reporting facilities increased from 299 to 336, representing a 

20% increase in total on-site releases and a 14% increase in reporting facilities. 

• The reporting of HCB releases does not have a quantitative threshold, but is based on 

specific activities. Any facility that uses or engages in specified fuel combustion, metal 

smelting, production and waste incineration-based activities that have the potential to 

incidentally manufacture HCB must submit an NPRI report. 

• In 2002, the sectors that reported the largest amount of HCB releases were electric 

power generation, metal manufacturing, and mining and smelting. Typically, HCB is a byproduct of chemical manufacturing, wood preservation plants and waste combustion. 
37 

Figure 3.13: On-site releases to air, water and soil of mercury and its compounds 

reported in the NPRI for Canada, 1994–2002 

0

2

4

6

8

1994 1995 1996 1997 1998 1999 2000 2001 2002

Year

On-site releases (tonnes)

0

50

100

150

200

250

300

350

Number of facilities

Releases

Facilities

New reporting

threshold

Source: National Pollutant Release Inventory, Environment Canada

Notes: On-site releases to air include stack and point emissions; releases to water include water 

discharges; and releases to land include fill and treatment. These numbers do not include spills, leaks and 

fugitive emissions, nor do they include underground injection or off-site transfers for recycling or disposal. 

Key Observations: 

• In 2000, mercury releases increased dramatically to 6.2 tonnes, decreasing slightly to 5.8 

tonnes in 2002. This overall increase is due to a reduction in reporting threshold, from 10 

tonnes to 5 kg. 

• As a result of the change in reporting threshold, the number of reporting facilities 

increased from 5 in 1994 to 308 in 2002. In 2002, 5.4 tonnes (93% of total on-site 

releases) were air releases. 

• The sectors that emitted the greatest quantity of mercury were electrical power 

generation and base metal smelting. 
38 

Mercury levels in fish 

Fish consumption is an important source of 

mercury exposure. Consumption of shark, 

swordfish and fresh and frozen tuna should 

be restricted to one meal per week. For 

young children, pregnant women and women 

of child-bearing age, consumption should be 

limited to one meal per month. 

For more information on fish consumption 

and mercury, consult: 

http://www.inspection.gc.ca/english/corpaffr/f

oodfacts/mercurye.shtml 

Figure 3.14: Total atmospheric releases of mercury in Canada, 1990–2000 

0

5

10

15

20

25

30

35

40

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Year

Releases (tonnes)

Source: Environment Canada (2003b) 

Key Observations: 

• Mercury emissions to air saw an overall decrease of 77% 

from 1990 to 2000. 

• Emissions were reduced primarily from incineration 

operations, as well as the steel and primary base metal 

sectors. However, emissions from electric power 

generators increased over this time period. 

For more information, see the indicator template in Appendix 3. 

Legislative and Policy Framework: 

New substances, which include chemicals, polymers and 

products of biotechnology, are assessed before their release into 

the marketplace. However, all the substances monitored by 

Canada’s NPRI are existing substances rather than new substances. An existing substance is 

one that has been or is currently used in Canada as a commercial substance or product or is 

released into the Canadian environment on its own or as an effluent, mixture or contaminant. 

Toxic substances come from many industrial and household sources. CEPA 1999 provides for 

the assessment and management of substances that can enter into the Canadian environment. 

Under Section 64 of CEPA 1999, a substance is defined as “toxic” if it enters or may enter the 

environment in amounts or under conditions that may pose a risk to human life or health, to the 

environment or its biological diversity or to the environment on which life depends. Sixty-eight 
39 

substances are defined as “toxic” by CEPA 1999. These substances can be harmful to the 

environment, aquatic life, endangered species and human health (Environment Canada, 2004). 

All eight substances reported in these two indicators have been listed as “toxic” under CEPA 

1999. These substances are subject to various risk management measures, thereby reducing or 

eliminating risks to human health and the environment posed by their use and/or release. The 

Toxics Management Process is the consultative approach taken to develop management tools for 

substances determined to be toxic under CEPA 1999. Under this process, Environment Canada 

and Health Canada prepare a risk management strategy, which outlines the proposed approach 

for reducing risks to human health or the environment posed by a substance found toxic under 

the Act. For more information on risk management measures for each substance, see the 

indicator template in Appendix 3. 

Opportunities for Improvement: 

PRTR indicators could be improved by providing a more complete picture of total emissions to the 

environment. Comprehensive inventories, as were done for atmospheric releases of mercury and 

lead, are also extremely useful for estimating the total releases to the environment, by including 

sources not covered under the NPRI—which may constitute the main sources of emissions for 

some substances (e.g., motor vehicle emissions for benzene). 

Similarly, only facilities meeting the reporting requirements are required to report to the NPRI. 

Recent changes to reporting thresholds do, however, increase the number of facilities reporting 

annual releases. For many substances, scientific evidence shows that adverse health effects are 

associated with very low levels of exposure (especially in utero). Furthermore, many of the 

substances of concern to children’s health are non-threshold toxicants—in other words, there are 

no “safe” levels of exposure (e.g., lead). Reporting thresholds should be lowered to reflect the risk 

associated with low levels of exposure. 

Additional indicators that could be appropriate to use in this area are actual levels of these 

chemicals in ambient air, water, soil and food, which would give a better indication of the fate of 

those chemicals in the environment and sources of human exposure. They would also indicate 

whether the chemical load to the environment is increasing or decreasing over time. Another 

approach to presenting the data would be to report geographically (i.e., using geographic 

information systems) by representing communities that may be more at risk than others, based 

on the type and amount of substances emitted locally. 

The best indicator of children’s exposure to specific chemicals would be biomonitoring data (e.g., 

levels of chemicals in urine, blood, etc.). Biomonitoring data provide a measure of the current 

body burden of a chemical in an individual.

CASE STUDY 

Northern Aboriginal people in Canada 

The Northern Contaminants Program was established in Canada in 1991 in response to concerns about 

human exposure to elevated levels of contaminants in fish and wildlife species that are important to the 

traditional diets of northern Aboriginal people in Canada. The primary contaminants of concern in the context 

of traditional/country food consumption in Arctic Canada are the persistent organic pollutants (POPs), 

including polychlorinated biphenyls (PCBs), chlordane and toxaphene, the toxic metal mercury and naturally 

occurring radionuclides.

The Northern Contaminants Program found that Inuit mothers had oxychlordane and trans-nonachlor levels 

in maternal/cord blood that are 6–12 times higher than levels in Caucasians, Dene and Métis, or other 

mothers. Similar patterns were observed for PCBs, HCB, mirex and toxaphene. Recent research has also 

revealed significantly higher levels of mercury in maternal blood of Inuit women, when compared with other 

mothers.
40 

Most health risk uncertainty related to the presence of contaminants in the Arctic food chain is due to 

methylmercury and POPs. One of the research priorities of the Northern Contaminants Program is to study 

prenatal exposure to environmental chemicals and adverse developmental effects on immune system and 

nervous system function early in life. Neurobehavioural and immune function effects of prenatal exposure to 

environmental chemicals are being studied in prospective longitudinal cohort studies starting during 

pregnancy (Van Oostdam et al., 2003). 
41 

MEME MODEL

EXPOSURE INDICATOR 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal 

Proximal 

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

3.4 Pesticides 

Indicator 8: Pesticides 

Issue, Context and Relevance of the Indicator:

Recent advances in scientific understanding reaffirm that children are 

not “little adults” and that they have unique vulnerabilities to the 

potential health effects of pesticides. Two elements distinguish infants 

and children from the adult population: 

1) Biological considerations. The developing fetus, infants and 

children are in a state of rapid growth, with cells dividing and organ 

systems developing. Some organ systems mature in early 

childhood, and others are not fully developed until adulthood. 

Children have a higher ratio of skin surface area to body weight 

than adults, and, on a weight for weight basis, children eat more 

food, drink more water and breathe more air than adults. As a 

result of these biological differences, children may absorb, metabolize and excrete chemicals 

differently from adults, potentially resulting in differing levels of susceptibility to chemical 

hazards. 

2) Unique exposures. In addition to exposure through minute residues that may remain on some 

food, such as fruits and vegetables, children may be exposed to pesticide residues in breast 

milk, in formula, through skin contact with treated surfaces while crawling and playing and 

through incidental ingestion from behaviours such as hand-to-mouth transfer (PMRA, 2002).

Estimates of exposure from food are derived from two distinct pieces of information: the amount 

of a pesticide residue that is present in and on food (i.e., the residue level) and the types and 

amounts of foods that people eat (i.e., food consumption) (PMRA, 2003). 

Pesticide residues can occur in or on food. Residue levels are determined based on a number of 

sources of information, including crop field trials and monitoring programs, use information, and 

commercial and consumer practice information, such as washing, cooking, processing and 

peeling practices. 

The Canadian Food Inspection Agency (CFIA) is responsible for monitoring domestic and 

imported foods and carrying out enforcement actions to prevent the sale of food containing 

excessive residues. 

Indicator—Status and Trends: 

This indicator reports the yearly number of organophosphate (OP) pesticides detected on 

domestic and imported fruits and vegetables, expressed as a percentage of sample size (Figure 

3.15). This indicator is a weak surrogate of children’s exposure to pesticides in foods because of 

the uncertainty inherent in the scope of the monitoring program: 

• The CFIA residue monitoring program is optimized for enforcement purposes, not specifically 

for children’s exposure. 

• The number of OP pesticides entering the market and the time and size of samples are not 

uniform over the years. 

Detection of low levels of residues does not necessarily represent a risk. Risk is assessed by 

comparing total exposure to a pesticide or group of pesticides with the toxicity profile of the 

pesticide(s) involved. 
42 

Figure 3.15: Percentage of sampled fresh fruits and vegetables with detectable 

organophosphate pesticide residues, Canada, 1995–2002 

Fruits and vegetables

0

5

10

15

20

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

% positives

Domestic

Imported

Both

Source: Canadian Food Inspection Agency, Chemical Residue Annual Reports 1994–1998 and 2001–2002 

Key Observations: 

• Over a several-year period, the percentage of fresh fruits and vegetables with detectable 

OP pesticide residues has decreased, suggesting reduced exposure from this source. 

For more information, see the indicator template in Appendix 3.

Legislative and Policy Framework:

Health Canada’s Pest Management Regulatory Agency (PMRA) is the federal agency 

responsible for the regulation of pest control products in Canada. The PMRA also develops pest 

management policies and guidelines, promotes sustainable pest management, looks to improve 

the regulatory process to increase efficiency, enforces compliance with the legislation and 

distributes pest management information to the general public and key stakeholders. 

Health Canada has codified special considerations of children and vulnerable populations in the 

new Pest Control Products Act. Child-protective health risk assessments are conducted for 

children, based on foods that children consume and anticipated residues. The unique food 

consumption patterns of infants and children, including breast milk, formula and fruit juice, are 

used in the risk assessment. It is important to recognize that many factors influence risk to 

children, and detection of residues on foods does not necessarily represent a risk. 

When assessing risks from pesticide residues in food, additional safety factors for infants and 

children are applied where warranted. This is to ensure protection of vulnerable subpopulations. 

Available information on aggregate exposure from a single pesticide is considered. This includes 

exposure through dietary and drinking water sources and other non-occupational exposures such 
43 

as arise from use of pesticides in and around homes. Available information on cumulative effects 

of pesticides with a common mechanism of toxicity is considered. The CFIA is responsible for 

monitoring the food supply and enforcing the specific maximum residue limits for all Canadian 

foods, whether domestic or imported products. 

Opportunities for Improvement:

Biomonitoring data, measuring the levels of pesticides and their metabolites in urine, are the best 

indicators of children’s exposure to pesticides. In order for biomonitoring results to be meaningful, 

it is critical that they be collected using appropriate study design and sampling methodology. 

The PMRA will soon implement a mandatory adverse effect reporting system for pesticides for 

Canada and anticipates that age-related information may be available by 2008. 

What You Can Do 

For more information on the consideration of children in the regulation of pesticides, visit 

Children’s Health Priorities within PMRA at: 

http://www.pmra-arla.gc.ca/english/pdf/spn/spn2002-01-e.pdf 
44 

MEME MODEL

ACTION INDICATOR 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal

Proximal

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

4 Waterborne Diseases 

4.1 Drinking Water 

Indicator 9: Percentage of children (households) without 

access to treated water 

This information is currently not available in Canada. 

The percentage of children served with treated water is not available 

in Canada. Canada is reporting the percentage of Canadians not 

connected to public water distribution systems. This information is 

not meant to indicate that the risks associated with private water supplies are necessarily 

higher—they are less well known on a national basis. As such, the information provided below is 

intended to highlight an important information gap. 

Issue, Context and Relevance of the Indicator: 

Access to clean water is critical for reducing the risk of exposure to waterborne pathogens to a 

minimum. Most centralized water distribution systems in Canada are equipped with filtration and 

disinfection processes (e.g., chlorination, ozonation) designed to kill bacteria and other pathogens 

that may be present in source water (either surface water or groundwater). Most of these 

distribution systems are also equipped with water treatment processes that may improve the taste 

and odour of the water and reduce the concentration of various chemicals in the water. 

In 1999, it is estimated that 23.7 million Canadians were on public distribution systems, while 6.8 

million depended on private supplies, mostly groundwater wells (Municipal Water Use Database 

survey, Environment Canada). There is no national program for tracking how many private wells 

have water treatment or disinfection systems and how many are subject to contamination. 

However, according to various surveys, nitrates and bacteria represent by far the most common 

well water contaminants in Canada. It is estimated that 20–40% of all rural wells have nitrate 

concentrations or coliform bacteria occurrences in excess of drinking water guidelines (Van der 

Kamp and Grove, 2001). Specifically, studies in Saskatchewan and Ontario have found that 

roughly 30–35% of surveyed wells exceeded drinking water guidelines for bacteria, while 

approximately 8% of wells in Alberta exceeded those guidelines (Rudolph and Goss, 1993; 

Fitzgerald et al., 1997; Sketchell and Shaheen, 2001). Ninety-two percent of private wells in 

Alberta and 99% in Saskatchewan exceeded Canadian guidelines for one or more health and 

aesthetic parameters (i.e., those that affect taste and/or odour, stain clothes and encrust or 

damage plumbing) (Corkal, 2003). Groundwater contamination may come from a variety of 

sources, including manure storage and application, septic systems, accidental spills and pesticide 

application. 

Indicator—Status and Trends: 

This indicator presents the percentage of Canadians not connected to public water distribution 

systems in their homes (Figure 4.1). The percentage of children without access to treated water 

could not be derived for Canada at this time. The indicator is based on surveys conducted every 

2–3 years (Municipal Water Use Database survey, Environment Canada). These surveys include 

municipalities with populations of over 1000, which covered about 25.4 million Canadians or 83% 

of the total population in 1999. Canadians not covered by the survey, those living in small rural 

municipalities, are expected to be mostly served by private individual water supplies, such as 

groundwater wells. It is assumed that Canadians on public distribution systems have a very low 

risk of being exposed to waterborne diseases unless there is a failure in technology or 

management of the water distribution system, which, despite best efforts, occasionally occurs. Of 

the Canadians served by public water distribution systems, only 1.8% were without centralized 

disinfection in 1999 and relied almost entirely on groundwater for their drinking water supplies. 
45 

Figure 4.1: Percentage of Canadians not connected to public water distribution 

systems, 1991, 1994, 1996 and 1999

0

25

50

75

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Year

% of Canadians

Source: Municipal Water Use Database, Environment Canada (consulted December 2003); and Statistics 

Canada (consulted December 2003) (for total population) 

Note: It is assumed that most Canadians not surveyed by the Municipal Water Use Database survey, living 

in municipalities with a population below 1000, are served by private water systems, mostly groundwater 

wells. 

Key Observations: 

• The percentage of Canadians with access, in their home, to water obtained from a private 

individual source has remained constant at about 22–23% between 1991 and 1999. This 

represented about 6.8 million Canadians in 1999. 

• Canadians not connected to public water distribution systems live mostly in rural areas. 

Nationally, it is not known how many people have wells that are subject to contamination 

or how many treat or disinfect their water before consumption

For more information, see the indicator template in Appendix 3. 

Legislative and Policy Framework: 

The division of responsibilities for managing water in Canada is complex, and responsibilities are 

often shared among federal, territorial and provincial governments. Overall, provincial 

governments are responsible for long-term as well as day-to-day management of water 

resources. Recently, Canada’s territorial governments have been acquiring more and more 

provincial-like responsibilities for water. 

Provincial governments have developed a substantial range of policies, regulations, strategies 

and frameworks to enhance the safety of drinking water supplies. The priorities and specific 

approaches may vary according to the management needs and specific circumstances of 

individual jurisdictions. 

There are many issues shared by all jurisdictions in Canada that benefit from collaborative 

approaches. For example, federal, provincial and territorial health and environment departments 
46 

have developed a comprehensive source-to-tap approach to protecting water quality, which 

includes watershed management. 

The multiple-barrier approach to protecting drinking water looks at all components of a drinking 

water system and identifies safeguards needed to provide safe drinking water. The components 

include source water protection, drinking water treatment and distribution systems. The 

safeguards include management, monitoring, research, science and technology development, 

guidelines, standards and objectives, legislative and policy frameworks, and public involvement 

and awareness. The elements of a successful drinking water program can include state-of-the-art 

facilities, operation certification, an effective compliance assurance program with emergency 

response protocols and measures to ensure public confidence. 

The protection of source water is the critical first barrier in the multiple-barrier approach to 

protecting drinking water. This extends beyond controlling individual sources of contamination to 

address problems and solutions on a regional or watershed basis. Many provincial and territorial 

jurisdictions, as well as local governments, are already managing water quality programs with a 

watershed approach (adapted from Government of Canada, 2003b). 

What You Can Do 

For more information on water quality and health, see: 

http://www.hc-sc.gc.ca/waterquality 

Opportunities for Improvement:

An improvement to this indicator would be to reflect the population of children with access to 

public water distribution systems, as opposed to the overall Canadian population. 

This indicator is not a direct measure of water quality, nor does it reflect improvements or failure 

in drinking water management and technology. More detailed surveys in future are expected to 

allow the reporting of population serviced by technology type (disinfection, filtration type) and 

general plant performance. This indicator does not provide information on a relatively large 

segment of the total population (around 17%), mostly in rural areas, which may be more at risk 

from untreated groundwater sources. Nationally collected data on the extent and type of well 

water contamination would improve our ability to track the extent to which Canadians may be 

exposed to pathogens and harmful chemicals. 
47 

MEME MODEL

EXPOSURE INDICATOR 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal 

Proximal 

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

Indicator 10: Percentage of children living in areas served by public water systems in 

violation of local standards 

This information is currently not available in Canada. 

One method of tracking whether drinking water poses a potential risk to health 

is to report on the percentage of children served by drinking water systems in 

violation of local standards. In Canada, a violation of drinking water standards 

does not necessarily mean that drinking water from a system is unsafe—it 

indicates that on at least one occasion, a water quality standard has been 

exceeded. These range from aesthetic measures, such as taste and odour, to 

the measurement of the presence of health-related contaminants. 

In Canada, drinking water quality data and adverse water quality incidences 

are requested from municipal systems and collected by the provinces. This 

information is not available from a national perspective. In all provinces, a 

number of safeguards are in place to deal with these violations, such as boil 

water advisories when the equipment fails or when Escherichia coli or other fecal coliforms are 

detected. Canada has no comprehensive national data on boil water advisories. 

In order to report on this indicator in the future, detailed analysis of water quality data in each 

province would be required to generate comparable data on a national level. Such analysis could 

begin with a selected number of specific water quality standards that are of particular concern to 

children’s health (e.g., certain bacteriological standards, chlorinated disinfection by-products, 

nitrates, etc.). 
48 

MEME MODEL

ACTION INDICATOR 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal 

Proximal 

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

4.2 Sanitation 

Indicator 11: Percentage of children (households) that are not served with sanitary sewers 

This information is currently not available in Canada. 

The percentage of children that are not serviced by centralized sewage treatment is not available 

in Canada. Canada is reporting the percentage of Canadians on sewers with or without treatment 

and the percentage on sewers with secondary or tertiary sewage treatment. 

Issue, Context and Relevance of the Indicator: 

Sanitary sewage, especially when it is not disinfected, can be an important 

source of pathogens to receiving water bodies. This presents a potential risk 

for children engaged in aquatic recreational activities or drinking untreated 

water in the area of influence of an outfall. A further threat includes the 

contamination of shellfish harvesting areas. A number of toxic substances can 

also be released with municipal sewage, posing an additional threat to 

children’s health. Poorly managed municipal sewage remains one of the 

biggest threats to water quality (Environment Canada, 2001). 

The quality of municipal sewage effluents is dependent on what goes into the 

collection system and the specific equipment and processes used for 

treatment. Secondary treatment using biological or physicochemical processes generally exhibits 

better performance than primary treatment (using screening and settling only) for reducing the 

loadings of a number of substances found in sewage. Tertiary or advanced treatment can be 

used to further reduce specific substances, such as phosphorus or nitrogen. All forms of 

treatment can be equipped with disinfection processes (e.g., chlorination/dechlorination, 

ozonation and ultraviolet radiation) to reduce or eliminate the presence of pathogens in the 

effluent. 

In Canada, municipalities and Government departments conduct routine monitoring of bacterial 

counts at most beaches and shellfish harvesting areas throughout the applicable parts of the year 

and following events that may result in water contamination (e.g., rainfall). Fecal coliform or E. 

coli counts are typically used as indicators of the presence of pathogens (e.g., viruses and 

protozoan parasites) in the water. Shellfish harvesting and beach closures can occur temporarily 

when bacterial counts exceed the established guidelines. In 1999, 3115 km2 of shellfish growing 

areas in British Columbia and the Atlantic provinces were closed due to bacterial contamination 

from municipal wastewaters and a number of other sources (Environment Canada, 1999a; 

Menon, 2000). In Quebec, of the 196 shellfish zones evaluated in 1999, 58% were permanently 

closed and 11% were closed between June 1 and September 30 (Environment Canada, 1999b). 

Beach closure data are not collected nationally; however, beach closures can occur frequently in 

some areas. 

It should be noted that bacterial counts are not a perfect measure of the presence of pathogens in 

the water but are much more cost-effective than directly trying to identify pathogens. Furthermore, 

results from bacterial counts typically take a day or two to be known, resulting in potential 

exposure before action is taken. 

As most Canadians are serviced by either municipal sewer systems or private septic systems, 

direct contact with or exposure to human wastes around households is not thought to be a major 

problem in Canada. 

Indicator—Status and Trends: 

This indicator presents the percentage of Canadians on sewers with or without treatment and the 

percentage on sewers with secondary or tertiary sewage treatment (Figure 4.2). The indicator is 

based on surveys conducted every 2–3 years (Municipal Water Use Database survey, 
49 

Environment Canada). These surveys include municipalities with populations of over 1000, which 

covered about 25.4 million Canadians or 83% of the total population in 1999. 

Figure 4.2: Percentage of Canadians on sewers and those with secondary or 

tertiary sewage treatment, 1991, 1994, 1996 and 1999 

0

25

50

75

100

1991 1994 1996 1999

Year

% of Canadians

Population on sewers

Population with secondary or

tertiary treatment

Source: The Municipal Water Use Database, Environment Canada

Note: It is assumed that most Canadians not surveyed by the Municipal Water Use Database survey, living 

in municipalities with a population below 1000, are serviced by on-site treatment, such as septic tanks. 

Key Observations: 

• In 1999, 22.7 million Canadians (or 74% of the total population), living mostly in urban 

areas, were serviced by municipal sewer systems. This level has remained relatively 

constant throughout the 1990s. 

• The remaining Canadians not serviced by sewage collection systems, about 7.8 million 

people, were generally served by private septic tanks, which are routinely pumped out 

and trucked to communal treatment facilities. When not properly installed and 

maintained, septic systems have the potential to contaminate nearby water bodies and 

groundwater sources. 

• The percentage of urban Canadians served by secondary sewage treatment or better 

increased from 48% to 58% between 1991 and 1999. This increase largely reflects 

infrastructure upgrades. A higher proportion of Canadians living in coastal areas were 

served by lower levels of treatment (primary or none). 

• About 70% of Canadians served by sewage collection systems in 1999 had effluent 

disinfection. 
50 

For more information, see the indicator template in Appendix 3. 

Legislative and Policy Framework: 

In Canada, responsibility for the collection and treatment of municipal wastewater, the 

administration and performance of wastewater facilities and the control of environmental and 

health impacts of municipal wastewater is shared across all levels of government. 

Municipal governments have the most direct responsibility for wastewater, by having the statutory 

mandate to provide sewage treatment. Municipalities also have the power, usually through a 

provincial/territorial municipal act, to control discharges into the sewer systems. Many 

municipalities have taken advantage of these powers to pass sewer use by-laws that are meant 

to reduce the toxicity of the effluents and establish source control. For example, the Regional 

Municipality of Ottawa-Carleton is active in reducing or eliminating toxic inputs to its treatment 

systems through the Industrial Waste Sewer Use Control Program. All industrial, institutional and 

commercial facilities that discharge non-domestic wastewater or have their liquid waste hauled to 

the wastewater treatment plant are required to comply with the Sewer Use By-law, which sets 

limits for various pollutants being discharged into sewers. 

The provincial/territorial governments are primarily responsible for the regulation of municipal 

sewage treatment operations, and most provinces/territories maintain legislative control through 

waste control statutes that apply directly to sewage effluent. Operators of wastewater systems 

are required to seek approval from their provincial/territorial governments, and these 

provincial/territorial permits or licences may specify maintenance and treatment requirements on 

top of what is already stipulated in regulations. The approvals may also contain specific limits on 

the discharge of effluents. For example, British Columbia’s Waste Management Act requires all 

municipalities to have a provincially approved Liquid Waste Management Plan. Discharges 

without such a plan are illegal in this province. The provinces/territories also generally have costsharing agreements with the municipalities for sewage-related infrastructure projects. 

Currently, there is no federal legislation directly governing the deposit of harmful substances by 

municipalities into their wastewater. There are two acts, however, that do have the potential to 

apply to municipal wastewater. The Fisheries Act is enforced federally by both Fisheries and 

Oceans Canada and Environment Canada and addresses a general prohibition against the 

release of a “deleterious substance” into waters frequented by fish. CEPA 1999 governs the 

release of toxic substances to the environment and allows the federal government to create 

regulations to control or eliminate the use of such substances. 

Private industry, research and educational institutions, conservation authorities and individual 

Canadians also have an important influence on decisions concerning wastewater management. 

Actions by all of these groups have ensured that the standard of wastewater management in 

Canada compares well with that of any other country. However, municipal wastewater is still a 

major contributor to the degradation of aquatic habitat, the fouling of recreational waters, the 

contamination of shellfish growing areas and other environmental and health concerns 

(Environment Canada, 2001). 

Opportunities for Improvement: 

New surveys being conducted will help better determine the treatment and disinfection 

technologies used by municipalities and provide better measures of their performance for 

removing wastes. Current data collection at a national level does not permit us to evaluate how 

many people have private septic systems that pose a risk for drinking water sources, shellfish 

harvesting or recreational waters. Information on the number and extent of sewage bypasses at 

treatment plants, as well as the number of plants violating provincial discharge regulations, would 

also improve existing survey information and provide an indication of how well treatment plants 

are managed. 
51 

MEME MODEL

HEALTH OUTCOME INDICATOR 

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal 

Proximal 

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

4.3 Waterborne Diseases 

Indicator 12: Morbidity: number of cases of childhood illnesses attributed to waterborne 

diseases 

Issue, Context and Relevance of the Indicator: 

Recent outbreaks of waterborne diseases in Walkerton, Ontario, and North 

Battleford, Saskatchewan, have heightened Canadian awareness of the fact 

that threats to water quality and quantity can have a profound impact on their 

health, the environment and the economy. 

The risk of microbial disease associated with drinking water is a concern 

among North American water jurisdictions. Numerous past outbreaks, 

together with recent studies suggesting that drinking water may be a 

substantial contributor to endemic (non-outbreak-related) gastroenteritis, 

demonstrate the vulnerability of many North American cities to waterborne 

diseases. These findings have fuelled debates in Canada and the United States and highlight the 

need for stricter water quality guidelines, changes in watershed management policies and 

additional water treatment (Lim et al., 2002). 

Enteric, foodborne and waterborne diseases are caused by a variety of microorganisms. 

Infections usually result when the microorganism enters the body though the mouth, either by the 

consumption of contaminated food (foodborne) or water (waterborne) or via contaminated fingers 

or objects. Waterborne diseases are those infections due to contaminated water. Given multiple 

causes of enteric diseases and common symptoms, it is difficult to determine the source of the 

pathogen (foodborne, waterborne). Giardiasis, sometimes called “beaver fever,” is an intestinal 

parasitic infection characterized by chronic diarrhea and other symptoms. Giardiasis may be 

foodborne, but transmission is common where personal hygiene may be poor. Community 

outbreaks may occur by ingesting Giardia cysts from fecally contaminated food or unfiltered 

water. Persons with acquired immunodeficiency syndrome (AIDS) may have more severe and 

prolonged illness. 

Cases are not reported to the Notifiable Diseases Registry until the individual seeks assistance in 

the primary care system and the primary care provider reports information to the 

provincial/territorial health unit. Public health scientists acknowledge that these illnesses are far 

more common than the reported numbers suggest. Estimates from studies in North America and 

Europe indicate that as few as 1–10% of cases are reported. This may, in part, reflect the mild 

nature of many infections, which are managed at home, or the fact that only a small proportion of 

patients have specimens taken for laboratory tests (Government of Canada, 1999). Limitations of 

the registry include underreporting, timeliness of reporting, disease case definitions and passive 

surveillance. 

Indicator—Status and Trends: 

In Canada, morbidity related to waterborne diseases is tracked in the national Notifiable Diseases 

Registry. Data are available for giardiasis from 1983 to 2000, which are the years in which this 

disease was reportable. The indicator is the incidence of giardiasis (number of new cases per 

100 000 population) in the Canadian population aged 19 and under from 1988 to 2000 (Figure 

4.3). 
52 

Figure 4.3: Incidence of giardiasis among children, by age group, Canada, 1988–

2000 

<1 year

1–4 years

5–9 years

10–14 years

15–19 years

0

20

40

60

80

100

120

140

160

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Year

Number of new cases/100 000

Source: Notifiable Diseases Registry, Health Canada

Key Observations: 

• The number of new cases of giardiasis in Canada has been declining since 1988 (with 

the exception of the age groups 10–14 and 15–19, which showed a slight increase).

• Children aged 1–4 are most likely to be infected with Giardia compared with the rest of 

the population. In 2000, the incidence of giardiasis among children aged 1–4 years was 

60 cases per 100 000. This may be because they are more likely to be brought to a 

primary care provider, less likely to be breastfed, more vulnerable to infection than older 

children and also more likely to ingest contaminated recreational water while playing in 

warm weather. 

For more information, see the indicator template in Appendix 3. 

Legislative and Policy Framework: 

While no program specifically targets children, the Federal–Provincial–Territorial Committee on 

Drinking Water—which represents government departments with interests in drinking water 

quality (usually health and environment) at the federal, provincial and territorial levels—has 

developed a guidance document for managing drinking water supplies in Canada (Health 

Canada, 1996).

Opportunities for Improvement: 

Further studies would have to be done to link cases with their etiology in order to determine the 

proportion of reported cases of giardiasis caused by waterborne infection. Other methodologies, 

such as household surveys and physician reporting, could be used to collect information on cases 

of giardiasis in Canada, in order to address underreporting in the national Notifiable Diseases 

Registry. 
53 

Indicator 13: Mortality: number of child deaths attributed to waterborne diseases

This indicator was recommended for inclusion in the indicators report by the CEC Steering Group. 

However, in subsequent work, Canada and the United States decided not to report on this 

indicator. Mortality rates attributed to waterborne diseases in Canada and the United States are 

very low and do not provide meaningful information on drinking water quality. Mexico, however, 

will be reporting on an indicator of cholera mortality rates and mortality rates for diarrheic 

diseases. 
54 

5 Recommendations and Conclusions 

5.1 Recommendations for Improving Reporting on Indicators of 

Children’s Health and the Environment in North America 

There is an increasing body of epidemiological research linking exposures to environmental 

contaminants to child health outcomes. However, measuring the extent of those environmental 

exposures and the associated burden of disease in Canadian children requires appropriate 

environmental monitoring and health surveillance data. Furthermore, indicators need to be 

developed to adequately report and communicate this information. 

Reporting on a limited number of indicators (13) selected by the CEC has proven to be a 

challenge for Canada—the most significant challenge being data availability at the national level. 

The approach taken for Canada’s contribution to the first report on indicators of children’s health 

and the environment in North America has been to collect existing data at the national level. In 

doing so, it became clear that opportunities exist for collecting data from provincial, territorial and 

municipal governments, as well as other organizations. This would provide for more 

comprehensive reporting in future reports. In keeping with Council Resolution 03-10, Canada is 

committed to the continuous improvement of indicators of children’s health and the environment. 

This section highlights lessons learned and puts forward some recommendations for generating 

informative and relevant indicators on the state of the Canadian environment as it influences 

children’s health. Recommendations for improvement of specific indicators as well as, more 

generally, indicators in each of the MEME model indicator categories have been identified. 

5.1.1 Recommendations by Indicator—Canada 

Outdoor Air Quality (Indicator 1) 

Many factors affect the levels of air pollutants across Canada, such as weather, topography, longrange transport of air pollutants and sources of emissions. Therefore, national averages of 

ambient levels of air pollutants may not provide the most accurate measure of air quality across 

Canada. Efforts need to continue in Canada in order to generate indicators of outdoor air quality 

that better incorporate children’s population and their potential level of risk. In addition, future 

efforts could focus on generating indicators of local air quality to identify potential subpopulations 

of children, or geographic areas, that may be at increased risk of exposure to poor air quality—for 

example, children in certain high-industry regions or children living along major transportation 

corridors. In the future, generating indicators to measure both the long-term exposure of children 

to average levels of air pollutants as well as their exposure to peak air pollution events would 

provide better tools to track this important issue. 

Indoor Air Quality and Second-hand Smoke (Indicator 2) 

The Canadian Tobacco Use Monitoring Survey provides a good estimate of children’s exposures 

to second-hand smoke at home. However, this survey is conducted in French and English and 

may miss families that are not able to speak either language. Given that new immigrants and 

refugees to Canada are arriving from countries where smoking may be endemic, a study on the 

exposure of children of newcomers to Canada to second-hand smoke would provide a broader 

understanding of the issue. Biomonitoring surveys of cotinine levels in Canadian children (levels 

in blood, urine or saliva) would also provide a more complete picture of children’s exposure to 

second-hand smoke, including all sources of exposure—not just the home environment, but other 
55 

public places in which children live, learn and play. In addition, indicators for other parameters of 

indoor air quality could be developed—for example, mould in housing, VOCs from building 

materials and consumer products. 

Prevalence of Asthma (Indicator 3) 

The main issue is reliance on parents’ reports of physician-diagnosed asthma and the concern 

over the reliability of this diagnosis. Canada is currently reviewing and developing national 

guidelines for the prevention and management of asthma among children. The new pediatric 

clinical practice guidelines will include recommendations on how to diagnose asthma. Use of 

these guidelines will increase the accuracy of physicians’ diagnosis of asthma and hence parental 

reports of this diagnosis. Better indicators could be generated in the future by linking outdoor air 

quality indicators, especially episodes of poor air quality, with specific information on the 

associated health outcomes in children—for example, timing and occurrences of asthma attacks.

Exposure to Lead (Indicators 4 and 5) 

Although Canadian health departments have conducted blood lead screenings on pregnant 

women and children for many years, there has been no national blood lead survey in Canada 

since 1978. There is a volume of blood lead data from children that has been collected in specific 

areas throughout Canada, generally by provincial health departments, municipalities or other 

groups in response to a potential exposure. It has been proposed that a compendium of these 

findings be developed to provide an overview of children’s blood lead levels in Canada. 

Biomonitoring surveys (i.e., measurement of blood lead levels) of pregnant women, infants and 

young children would provide a more complete understanding of children’s exposures to lead at 

crucial points in their development. Biomonitoring surveys would allow the identification of 

subpopulations of children with potentially high blood lead levels and inform necessary health 

interventions. In addition, biomonitoring data would provide the information required to report on 

those subpopulations of children at higher risk. For example, blood lead levels could be linked to 

information on housing stock, hence improving the relevance of an indicator of “children living in 

homes with a potential source of lead.” 

Exposure of children to lead, as with many other toxic substances, is associated with persistent 

neurobehavioural effects, including cognitive deficits. Limited information exists in Canada on the 

prevalence of neurobehavioural disorders and learning disabilities. Better information on the 

health outcomes associated with lead exposure would allow better reporting on indicators on the 

effects of lead in children in Canada. 

Pollutant Release and Transfer Register (PRTR) Data (Indicators 6 and 7) 

In Canada, 274 substances are currently required to be reported to the NPRI. This inventory 

provides a wealth of information to citizens on which specific pollutants are released to air, water 

and land from facilities located in their communities, as well as the quantities sent to other 

facilities for disposal, treatment or recycling. This was Canada’s first attempt at prioritizing a vast 

amount of pollutant release data from a children’s health perspective. Future efforts could focus 

on selecting specific substances that are associated with adverse health effects in children and 

refining the reporting of PRTR data for those substances. 

The use of PRTR data to generate informative indicators is only beginning. Trends in pollutant 

release can provide “action” indicators measuring the effectiveness of government and industry 

interventions to reduce pollutant releases to the environment. Analysis of PRTR data needs to be 

refined if it is to provide meaningful indicators of children’s potential exposure to these 

substances. It is necessary to take into account the fact that the degree of human exposure is not 

necessarily proportional to the number of tonnes of pollutant released but depends on the 

environmental media (where the pollutant is released), its chemical behaviour and the routes of 
56 

exposure. Hence, the contribution of specific pollutant releases to ambient levels in outdoor air, 

concentrations in water and food contamination needs to be assessed. Another approach to 

presenting pollutant release data would be to report geographically by representing communities 

(and subpopulations of children) that may be more at risk than others, based on the type and 

amount of pollutants emitted locally. 

The best indicator of exposure to specific chemicals would be the collection of biomonitoring data 

of children in Canada. 

Pesticides (Indicator 8) 

The best measure of the exposure of pregnant women, fetuses and children to pesticides would 

be biomonitoring data (i.e., levels of pesticides or their metabolites in blood, urine and breast 

milk). 

The PMRA will soon commence a database of adverse effects from exposure to pesticides. In 

addition, measurement of multiple exposures and resulting body burdens would greatly enhance 

our understanding and reporting in this area. Health effects surveillance could provide additional 

information on the adverse health effects in children associated with pesticide exposure. 

Consolidating data from poison control centres across Canada for pesticide poisonings should be 

examined for potential use in the future. 

Drinking Water Quality (Indicators 9 and 10) 

A national picture of drinking water quality in Canada would require integration, streamlining and 

analysis of provincial data on boil water advisories and water treatment plant violations of water 

quality standards. In Canada, all of the drinking water quality data for public systems are collected 

and categorized differently across the provinces and territories, which means that they are not 

readily available from a national perspective. As a matter of priority, these data could be analyzed 

for specific parameters of water quality that are critical to children’s health. In addition, there is no 

national system or program in Canada for reporting on the quality of water in private wells. This is 

an important area for improvement for future indicators, as bacteriological contamination of well 

water and high nitrate levels may be common in Canada and are of particular concern for 

children’s health. 

Sanitation (Indicator 11) 

As most Canadians are serviced by either municipal sewer systems or private septic systems, 

direct contact with or exposure to human wastes around households is not thought to be a major 

problem in Canada. However, better reporting on the level of sanitary sewage treatment, on both 

public and private systems, is important, since protection of source water is the critical first barrier 

to protecting drinking water. In addition, poor sewage treatment presents a potential risk for 

children engaged in aquatic recreational activities (e.g., beach closures) and contributes to the 

contamination of shellfish harvesting areas. An indicator of sewage treatment level as it may 

impact children’s health is an area for future development. 

Waterborne Diseases (Indicators 12 and 13) 

The Notifiable Diseases Registry captures outbreaks of waterborne diseases and diseases 

caused by identified organisms when infected individuals consult their primary care providers. 

Identifying the cause of each case of enteric disease in children would be a more effective way to 

identify the number of infections caused by contaminated water (as opposed to foodborne or 

fecal–oral route). Moreover, some people may not seek assistance from a primary care provider 

in response to their symptoms. Using data from the Notifiable Diseases Registry, therefore, 

underestimates the prevalence of waterborne diseases in Canada. Other methodologies, such as 
57 

MEME MODEL

Well-being 

Morbidity 

Mortality 

Exposure

Ambient 

environment 

Community 

Home 

Health outcome

Preventive 

actions

Remedial 

actions

Actions

Contexts

Distal 

Proximal 

Less 

severe 

More 

severe 

Social conditions 

Economic conditions 

Demographic conditions 

causes or 

is 

associate

attributab

le to or is 

associated

household surveys, could be used to collect information on morbidity associated with waterborne 

diseases. 

5.1.2 Recommendations by MEME Model Indicator Category 

Improving “Exposure” Indicators 

It is clear that there are many other known environmental threats to 

children’s health that are not reported through this initial set of 13 

indicators. Opportunities for improvements exist in developing additional 

indicators of exposure of children and pregnant women. Such indicators 

could address issues such as other parameters of indoor air quality, 

exposure to toxic substances through consumer products and exposure to 

chemical and bacteriological contaminants through food or water that are 

associated with adverse health effects in children. Occupational exposure 

of pregnant women to contaminants as well as the contribution of parental occupational exposure 

are also areas that deserve reporting. 

Improving “Health Outcome” Indicators 

Due to the inherent difficulty of linking an individual’s exposure to a subsequent disorder or 

disease, especially with low-dose, long-term exposures to environmental contaminants and the 

contribution of various other determinants of health (genetic, lifestyle, socioeconomic factors), 

developing sound “health outcome” indicators presents health experts and other practitioners with 

enormous challenges. As such, public health surveillance systems need to continue to refine the 

tracking of waterborne diseases, pesticide poisonings, hospital admissions or cardiorespiratory 

illness related to air quality, learning and behavioural disabilities, childhood cancers, reproductive 

health outcomes, etc. This information is important for a better overall reporting of the 

environmental burden of disease in children and the health care costs associated with 

environmental exposures. 

Improving “Action” Indicators 

As governments and other stakeholders develop interventions to address threats to children’s 

health in Canada, it becomes necessary to track the effectiveness of those interventions. Action 

indicators can be developed in each of the priority areas—outdoor and indoor air quality, 

exposure to lead and other toxic substances and water quality. A good set of “action” indicators 

would provide us with the signposts telling us whether we are on the right track for reducing the 

exposure of children to environmental contaminants and improving their health and well-being.

Improving “Context” Indicators 

It is important to understand the socioeconomic context that affects children’s exposure to 

environmental contaminants. Factors such as family income level, maternal education and 

geographic location (urban versus rural population) have already been identified and require 

further exploration. 

In keeping with the state of the science on the influences of the environment on children’s health, 

it is necessary to develop indicators on emerging issues—for example, endocrine disruptors and 

the impacts of climate change on children’s health. In Canada, the climate is a very real part of 

our physical environment. Climate change, which leads to changing weather patterns and 

increased numbers of extreme weather events, is expected to have a negative impact on the 

health of vulnerable populations, particularly children. This negative impact includes health effects 

associated with increased smog episodes, heat and cold waves, waterborne and foodborne 

contamination, diseases transmitted by insects, stratospheric ozone depletion and extreme 

weather events (Health Canada, 2003b). 
58 

In addition, we know that some segments of our population are exposed to unacceptably high 

levels of environmental pollutants. This report contains case studies of research on 

subpopulations of children, such as First Nations and northern Aboriginal populations, that may 

be disproportionately affected by environmental contaminants. There is no such thing as a 

“national” child in Canada. In the future, indicators will be needed to better understand the unique 

local environmental conditions and diverse realities facing children across Canada.

5.2 Conclusions 

Canada is committed to improving the reporting of indicators of children’s health and the 

environment. A good set of indicators would allow us to translate large amounts of complex 

scientific information into understandable measures. The first North American report lays the 

foundation for such work and has allowed Canada to identify opportunities for improved data 

gathering and for indicator development. This lays a path forward to future comprehensive 

reporting on the state of the Canadian environment as it influences children’s health and wellbeing. 

For tips on what you can do to protect children’s health and the environment, please consult the 

tip sheet included in Appendix 2, also available at: 

http://www.hc-sc.gc.ca/hl-vs/pubs/child-enfant/child_safe-enfant_sain_e.html 
59 

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Acknowledgements 

This publication was prepared by Environment Canada (EC) and Health Canada (HC), with 

assistance from the North American Commission for Environmental Cooperation (CEC). Annie 

Bérubé, working for both EC and HC, provided a major contribution to this project by overseeing 

a substantive portion of the development of the report, researching information, writing sections, 

editing, providing direction and coordination among and within the two Canadian departments 

and representing Canada on the Steering Group for the Development of Indicators of Children’s 

Health and the Environment in North America. Amber McCool (EC), Vincent Mercier (EC), 

Andrea Ecclestone (HC), Dr. Anthony Myres (HC), Susan Ecclestone (HC) and Nicki Sims-Jones 

(HC) also provided advice, research, writing, reviews and consultation with partners and 

reviewers and participated as members of the Steering Group. Andrea Ecclestone (HC), Emma 

Wong (HC) and Daniel Panko (HC) provided significant support in many aspects of the 

preparation of this report, including research, data integration and analysis, consultation with 

experts, writing and project management. Initial development of the project was also provided by 

Julie Charbonneau (EC), Risa Smith (EC) and Kerri Henry (EC). 

Advice, information and feedback on various sections and aspects of the report were provided by 

the following people: Bruce Dudley and Samantha Baulch (Delphi Group); Erica Phipps 

(consultant with the CEC); François Lavallée, David Niemi and Arun Chatterjee (National 

Pollutant Release Inventory Office, EC); Catherine Miller (Hampshire Research); Phil Blagden 

and Carrie Lillyman (Meteorological Service of Canada, EC); Domenic Mignacca (Air Pollution 

Prevention Directorate, EC); Liz LeFrançois (Sustainable Water Use, EC); Doug Trant, Giuseppe 

Filoso and Peter Morrison (Statistics Canada); Christine Norman, Mary Mitchell and Pierre 

Brassard (Pest Management Regulatory Agency, HC), Wendy Enright (Air Health Effects 

Division, HC) and Elaine Easson (Management of Toxic Substances Division, HC). 

A special thanks goes to Dr. Donald Wigle (Affiliate Scientist, Institute of Population Health, 

University of Ottawa), Dr. Theresa To (Senior Scientist, Hospital for Sick Children, Toronto) and 

Pumulo Rody (Project Manager, International Institute for Sustainable Development) for spending 

a significant amount of time in providing expert advice, direction and content review, on several 

occasions. 

Editing was provided by Marla Sheffer, translation by Les Entreprises Hélène Bruyère, formatting 

by the Delphi Group and conversion for the Internet by the CEC. 
66 

Appendix 1 List of Acronyms and Abbreviations 

μg microgram 

AIDS acquired immunodeficiency syndrome 

CEC North American Commission for Environmental Cooperation 

CEPA 1988 Canadian Environmental Protection Act 

CEPA 1999 Canadian Environmental Protection Act, 1999

CFIA Canadian Food Inspection Agency 

CMHC Canada Mortgage and Housing Corporation 

CO carbon monoxide 

COPD chronic obstructive pulmonary disease 

CTUMS Canadian Tobacco Use Monitoring Survey 

dL decilitre 

EMEP Cooperative Programme for Monitoring and Evaluation of the Long Range 

Transmission of Air Pollutants in Europe g gram 

HCB hexachlorobenzene 

km2

 square kilometre 

L litre 

LFS Labour Force Survey 

m3

 cubic metre 

MEME Multiple Exposure – Multiple Effect 

mg milligram 

min minute 

MUD Municipal Water Use Database 

NAPS National Air Pollution Surveillance 

NCP Northern Contaminants Program 

NLSCY National Longitudinal Survey of Children and Youth 

NO2 nitrogen dioxide 

NOx nitrogen oxides 

NPHS National Population Health Survey 

NPRI National Pollutant Release Inventory 

OP organophosphate 

PCB polychlorinated biphenyl 

PCDD polychlorinated dibenzo-p-dioxin 

PCDF polychlorinated dibenzofuran 

PM particulate matter 

PM2.5 particulate matter less than or equal to 2.5 micrometres in diameter 

PM10 particulate matter less than or equal to 10 micrometres in diameter 

PMRA Pest Management Regulatory Agency 

POP persistent organic pollutant 

ppb part per billion 

ppm part per million 

PRTR pollutant release and transfer register 

SIC Standard Industrial Classification 

SIDS sudden infant death syndrome 

SO2 sulphur dioxide 

SOx sulphur oxides 

SPF sun protection factor 

TCDD tetrachlorodibenzo-p-dioxin 

TEQ toxic equivalency 

TRI Toxics Release Inventory 

UNECE United Nations Economic Commission for Europe 

UV ultraviolet 

VOC volatile organic compound 
67 

Appendix 2 Healthy Environments for Children—What You 

Can Do! 

Children come into closer contact with their environment than adults. 

They crawl on the floor and the ground, put their fingers in their mouths and because of their 

curious nature touch and taste things without 

knowing if they are harmful. They may also be more 

sensitive to some harmful substances because of 

their stage of development. As a parent or caregiver 

you have an important role to play in providing a 

healthy environment for your child(ren). This 

appendix has information on what you can do and 

gives Internet links and telephone numbers for more 

information. Your local Public Health Department 

may have information on providing healthy 

environments for children. 

Washing Hands 

Hand-washing with warm water and soap after going 

to the bathroom, touching animals, and before every 

meal helps to prevent infection and reduce exposure to harmful 

substances your child may have touched. 

Tips for hand-washing include: 

• Use warm water. 

• Lather with soap for 10 to 15 seconds. Any soap will do. 

• Have your child(ren) sing a favourite song while handwashing to help them wash for a longer time. 

• Rinse hands and dry well with a clean towel. 

Taking Shoes Off When You Come Inside 

The soil outside your home can contain a number of substances you 

do not want inside. Taking your shoes off when you come inside is 

one way to reduce the amount of these substances in your home. 

Preventing Breathing Problems 

The quality of indoor and outdoor air affects children’s ability to breathe easily. 

To help your child(ren) breathe more easily: 

Outdoor Air 

• Listen to the radio or watch television reports for 

information about air quality and smog advisories. Plan 

your day based on this information. 

• Consider limiting or rescheduling physical outdoor 

activities on smog advisory days when air pollution is 

more harmful than usual. 

• Reduce exposure to motor vehicle exhaust by limiting 

physical activity near heavy traffic areas, particularly at rush hour. 

• Stop unnecessary vehicle idling. This is an easy way to help improve the air quality in 

your community. 
68 

Indoor Air 

• Prevent anyone from smoking in your car or home. Infants and children exposed to 

second-hand smoke are more likely to suffer from respiratory disease, ear infections, 

allergies and Sudden Infant Death Syndrome (SIDS). 

• Keep your home as clean as possible. Dust and vacuum rugs and upholstery regularly. 

For children with asthma, dust, mould and pet dander can trigger asthma attacks and 

allergies. 

• Reduce your use of aerosol sprays indoors. 

Protect Children from Too Much Sun 

Too much sun can be harmful. The sun’s ultraviolet (UV) rays can cause painful sunburn and 

lead to skin cancer. This is especially true for babies and children because their skin burns easily. 

To protect your child(ren) from the sun: 

• Keep babies under 1 year of age out of direct sunlight. 

They should be in the shade, under a tree, umbrella or 

stroller canopy. 

• Do not use sunscreen on babies less than 6 months old. 

Keep them in the shade. 

• Dress children in protective clothing (light colours with long 

sleeves and pants), including a broad brim hat, AND use 

sunscreen with a Sun Protection Factor (SPF) of at least 

15 whenever they are in direct sunlight. 

• Be sure to use lots of sunscreen lotion and reapply every 2 hours as well as after 

swimming. 

• Keep children out of the sun between 11 a.m. and 4 p.m. when the sun’s rays are 

strongest, unless they are well-protected by clothing and sunscreen. 

• Take extra care on days when the UV level is high. 

• Don’t think that children are safe just because it’s cloudy. The sun’s harmful rays can get 

through fog, haze, and light cloud cover. 

• Bring water or some juice for your child(ren). 

For more information on second-hand smoke, consult The Facts About Tobacco: What is 

Second-Hand Smoke? at http://www.gosmokefree.ca or call the Tobacco Control 

Programme at 1-866-318-1116. 

For information on air quality and health, visit Health Canada’s Air Quality website at 

http://www.healthcanada.ca/air or call the Air Health Effects Division at (613) 957-1876. 
69 

Protect Children from Carbon Monoxide Poisoning 

Carbon monoxide (CO) is a harmful gas that has no colour, odour or taste. Even at low levels of 

exposure, carbon monoxide can cause serious health problems. CO is harmful because it will 

rapidly accumulate in the blood, reducing the ability of blood to carry oxygen. 

To reduce the risk of exposure to CO: 

• Open your garage door before starting your car. 

• If you have a natural gas or propane clothes dryer, clean its 

ductwork and outside vent cover regularly to make sure they 

are not blocked. 

• Have a qualified professional check your furnace and chimney 

every year. 

• Check your fireplace to make sure the flues are open before 

lighting a fire. If the chimney does not draw, call a fireplace 

professional. 

• Do not use propane, natural gas or charcoal barbeque grills 

indoors, in an attached garage, or in any other enclosed area. 

• Never run gasoline-powered tools such as lawnmowers, 

snowblowers, or grass trimmers inside a garage. 

More tips to reduce the risk of exposure to CO 

• Avoid the use of all kerosene heaters indoors or in a garage. They produce CO and other 

pollutants. If you must use a kerosene heater indoors, be sure it is meant to be used 

inside. Review and follow the instructions before every use. 

• Put at least one CO detector in your home as a good safety precaution—in some cities it 

is the law. It is best to have one CO detector on each floor of your home. CO detectors 

should be replaced every 3 to 5 years. 

For more information on sun protection, please call the Consumer and Clinical Radiation Protection 

Bureau at (613) 954-6699 or visit the following websites: 

A Parent’s Guide to Sun Protection: Protecting Your Family 

http://www.hc-sc.gc.ca/hl-vs/securit/sports/sun-sol/protecting-proteger_e.html 

A Parent’s Guide to Sun Protection: Sun Fiction and Fact 

http://www.hc-sc.gc.ca/hl-vs/securit/sports/sun-sol/facts-realites_e.html 

Ultraviolet Radiation from the Sun 

http://www.hc-sc.gc.ca/english/iyh/environment/ultraviolet.html 

Sunglasses 

http://www.hc-sc.gc.ca/english/iyh/products/sunglasses.html 

Sunscreens 

http://www.hc-sc.gc.ca/english/iyh/lifestyles/sunscreen.html 

Information about Products Containing Sunscreen and DEET 

http://www.hc-sc.gc.ca/pmra-arla/english/pdf/pnotes/deet-e.pdf 
70 

Keep Pesticides Away from Children 

A pesticide is any substance used to control pests such as insects, mice and weeds. Pesticides 

are poisonous. Poison Control (Information) Centres across Canada often receive calls about 

children who have swallowed a pesticide that was not stored properly. 

To protect your children from coming in contact with pesticides: 

• Wash fruits and vegetables under running water before eating them.

• Avoid the use of pesticides in and around your home. Check for alternatives such as 

sealing cracks to prevent pests from entering your home. 

If you do need to use a pesticide product: 

• Review the pesticide product label or safety sheet carefully 

before every use. 

• Keep children, pets and toys away when pesticides are 

applied either inside or outside your home. If a pesticide 

comes into contact with toys, wash them with water before 

using. 

• Read the label or information sheet to find out when children 

can return to the treated area. If you are unsure of the 

recommended time, keep them away from the area for at 

least 24 hours. 

• Put up signs to notify neighbours where a pesticide has been used so their children may 

also be kept away from the treated area. 

• Store pesticides in their original containers. Children may mistake other containers for 

food or drink. 

• Store pesticides in a locked area out of the sight and reach of children. 

If your child has swallowed a pesticide: 

• Call a Poison Control (Information) Centre immediately and seek medical attention if you 

suspect your child has swallowed a pesticide. 

• Keep the phone number of the Poison Control (Information) Centre by the phone. Phone 

numbers of Poison Control (Information) Centres can be found at the front of your local 

telephone directory. 

• When you call the Poison Control (Information) Centre, you need to know the name of 

the product, amount taken, and the time of the incident. 

• Follow the first aid statement on the pesticide label and take the pesticide container or 

label with you to the emergency facility or physician. 

For more information on eliminating sources of CO in your home and CO detectors, visit 

http://www.cmhc-schl.gc.ca/en/burema/gesein/abhose/abhose_ce25.cfm or call the Canadian 

Housing Information Centre at (613) 748-2367. 
71 

Using Personal Insect Repellents Safely 

Parents and caregivers have always tried to protect their children from mosquito bites. Now that 

mosquitoes can carry the West Nile virus, there is even more concern about their bites. For most 

Canadians, the risk of illness from West Nile virus is low, and the risk of serious health effects is 

even lower. To help prevent mosquito bites, the use of a personal insect repellent should be 

considered. Never use personal insect repellents on children under 6 months of age, and for 

children under 2 years of age it is advisable to use mosquito netting around their carriages rather 

than personal insect repellents, unless a high risk of complications from insect bites exists. 

Repellents containing soybean oil, P-menthane 3,8-diol, Citronella, Lavender and DEET are 

currently registered for use in Canada. Mosquitoes are most active between dusk and dawn. To 

help prevent mosquito bites during this time, avoid mosquito areas and dress your child(ren) in 

long-sleeved, light-coloured clothing with a tight weave. 

For all types of personal insect repellents: 

• Read the label carefully before using. Pay special attention 

to the maximum number of applications allowed per day, 

the age restrictions for use, and the protection times.

• Do not put repellent on children’s faces and hands. This 

will reduce their chances of getting it in their eyes and 

mouths. If it does get into their eyes, rinse immediately 

with water. 

• Do not apply repellent on sunburns, open wounds or skin 

irritations. 

• Apply as little of the repellent as possible to exposed skin 

surfaces or on top of clothing. Never use it under clothing. 

• Put on insect repellent only in well-ventilated areas. Never 

use it near food. 

• If using a sunscreen product that contains insect repellent, 

use the product as a repellent and apply sparingly. 

• If using a separate sunscreen and repellent together, apply 

the sunscreen first, wait 20 minutes, and then apply the 

insect repellent. 

• Wash treated skin with soap and water when you return indoors or when protection is no 

longer needed. 

Guidelines for using personal insect repellents containing DEET include: 

For children under 6 months of age: 

• NEVER use personal insect repellents containing DEET. Instead consider alternative 

methods of protection such as protective clothing and mosquito netting. 

For children aged 6 months to 2 years: 

For more information on pesticide use, visit Pesticide Use In and Around the Home at 

http://www.pmra-arla.gc.ca/english/pdf/pnotes/homeuse-e.pdf or call the Pest Management 

Information Service at 1-800-267-6315. 

For more information about maintaining a healthy lawn, consult Healthy Lawns at 

http://www.healthylawns.net/english/index-e.html or call the Pest Management Information 

Service at 1-800-267-6315. 

For more information on pressure-treated wood, consult Health Canada’s Fact Sheet on 

Chromated Copper Arsenate (CCA) Treated Wood found at http://www.pmraarla.gc.ca/english/pdf/fact/fs_cca-e.pdf or call the Pest Management Information Service at 1-

800-267-6315. 
72 

• Apply once a day only in situations where a high risk of complications from insect bites 

exists.

• Use products labelled 10% DEET or less. 

• Avoid using over a prolonged period. 

For children between 2 and 12 years of age: 

• Apply no more than 3 times per day. 

• Use products labelled 10% DEET or less. 

• Avoid using for a prolonged period. 

For children of 12 years of age or older: 

• Use products labelled 30% DEET or less. 

Keep Mould Levels Down in Your Home 

Mould inside your home can be a health concern. Mould grows when there is too much humidity 

and condensation from building leaks, cooking, washing, flooding, etc. Mould can lead to allergic 

reactions and respiratory diseases. Reducing mould levels in your home is one way to help your 

child(ren) breathe more easily. 

To reduce the risk of exposure to mould: 

• Make sure that there are no wet spots in your house 

such as damp basements, leaking bathroom sinks, cold 

closets on exterior walls, etc. 

• Check for and fix water leaks. Repair leaky roofs, walls, 

and basements. 

• Ensure that your home is adequately ventilated. 

• Circulate air and prevent moisture build-up by installing 

and using exhaust fans vented to the outdoors in 

kitchens and bathrooms. 

• Check that your clothes dryer exhausts to the outdoors. 

Remove lint before every use. 

• Discard clutter and excess stored materials in 

basements. Moulds grow on fabrics, cardboard, paper, 

wood, and anything that collects dust and holds 

moisture. 

• Discard or clean water-damaged materials such as 

carpets quickly to avoid mould growth. 

• Wash or change shower curtains monthly and keep 

bathtub and shower areas free from mould build-up. 

• Get rid of mould on surfaces by removing the source of 

moisture. Scrub the mouldy area with a mild cleaning detergent. Rinse by sponging with 

a clean, wet rag. Repeat. Dry the area quickly and completely. Make sure that there is 

good air circulation when cleaning. 

• Cleaning up mould can be complex; for steps on cleaning up mould, consult Canada 

Mortgage and Housing Corporation’s Fighting Mold—The Homeowners’ Guide at 

http://www.schl.ca/en/burema/gesein/abhose/abhose_ce08.cfm 

For more information, please consult Safety Tips on Using Personal Insect Repellents at 

http://www.phac-aspc.gc.ca/wn-no/repellents-insectifuge_e.html for more tips or call the Pest 

Management Information Service at 1-800-267-6315. 

For more information on the West Nile virus, please see http://www.westnilevirus.gc.ca or 

call the National West Nile Virus Info-line at 1-800-816-7292. 
73 

Protect Children from Mercury in Fish 

Eating high amounts of mercury can cause damage to the nervous system. Pregnant women and 

young children are particularly vulnerable to the harmful effects of mercury. Of the different kinds 

of foods we eat, fish is usually the largest source of mercury. This is because mercury in lakes, 

streams and oceans can build up in the bodies of some fish. Fish are an excellent source of highquality protein and are low in saturated fat, which makes them a healthy food choice. 

To reduce the risk of exposure to fish contaminated by mercury: 

When eating fish bought from the store: 

• Limit eating swordfish, shark, or fresh and frozen tuna to one 

meal per month for young children, pregnant women, and 

women of child-bearing age. This restriction does not apply to 

canned tuna. 

When sport fishing: 

• Watch for local fish advisories that may indicate high levels of 

mercury and other contaminants in fish. 

• Contact your provincial authority for information about eating 

recreationally caught freshwater fish. 

• A list of provincial authorities is given at 

http://www.inspection.gc.ca/english/related/provincese.shtml, or check your phone book 

for a provincial government contact related to food, agriculture or fisheries. 

Protect Children from Polluted Water 

Good quality water is a high priority for everyone’s health, especially that of children. 

There are many potential sources of contamination, including agricultural runoff, 

faulty septic systems, and storm sewers. To reduce children’s exposure to polluted 

water, be alert for beach closings that result from bacterial contamination. 

For more information on well water, consult What’s In Your Well?—A Guide to Well Water 

Treatment and Maintenance at http://www.hc-sc.gc.ca/ewh-semt/water-eau/drinkpotab/well_water-eau_de_puits_e.html or call your local Public Health Department. 

For more information, visit Information on Mercury Levels in Fish at http://www.hcsc.gc.ca/english/protection/warnings/2002/2002_41e.htm or call the Canadian Food 

Inspection Agency at 1-800-442-2342.

For more information on measuring humidity in your home, consult the Canada Mortgage 

and Housing Corporation’s (CMHC) publication, Measuring Humidity in Your Home: Do You 

Have a Humidity Problem? at http://www.cmhcschl.gc.ca/en/burema/gesein/abhose/abhose_ce01.cfm 

For more information on bathroom and kitchen fans, consult CMHC’s The Importance of 

Bathroom and Kitchen Fans at http://www.cmhcschl.gc.ca/en/burema/gesein/abhose/abhose_ce17.cfm. For copies of these publications, call 

CMHC’s national office at 1-800-668-2642. 
74 

Providing Safe Drinking Water 

If your drinking water comes from a well, make sure it is safe by having it tested 2 or 3 times a 

year. 

Protecting Children from Exposure to Lead 

Lead is an inexpensive metal with many uses. However, it can cause many harmful health 

effects, especially to the nervous system and kidneys. Exposure to even very low levels of lead 

can cause learning disabilities and other harmful effects on children’s development. 

To reduce your family’s risk of lead exposure: 

• If your home was built before 1960, you should assume that 

lead was used in the original exterior and interior paint. Leaded 

paint that is chipping or peeling is a serious health hazard, 

especially to children who might eat it. In such cases the paint 

should be contained or removed following the guidelines in the 

booklet Lead in Your Home. Call the Canada Mortgage and 

Housing Corporation at 1-800-668-2642 to obtain a printed 

copy. 

• It is important to review this booklet before starting any 

renovation project in an older home. Renovations that are 

improperly carried out can greatly increase the risk of lead 

exposure from leaded paint. 

• Plumbing systems may have solder or other parts that contain lead. Because lead will 

leach into water sitting in pipes, always let the water run until it is cold before using it for 

drinking, cooking, and especially for making baby formula. Do not use water from the hot 

water tap for cooking or drinking. If you are concerned about elevated lead levels in your 

home’s drinking water, contact your local Public Health Department. 

• Costume jewellery containing lead is a health hazard for children who chew or suck on it. 

Ask when you purchase children’s jewellery to make sure it does not contain lead. 

• Discourage children from putting non-food items in their mouths. 

• When drinks are stored in leaded crystal containers some lead may dissolve into the 

liquid. Do not store liquids in lead crystal containers or serve pregnant women or children 

drinks in crystal glasses. 

Reducing Unintentional Exposure to Household Chemicals 

For more information on the health effects of lead, please call Health Canada’s Information 

and Education Health Unit at (613) 952-1014 or consult the following websites: 

Lead-based Paint: 

http://www.hc-sc.gc.ca/english/iyh/products/leadpaint.html 

Lead Crystalware and Your Health: 

http://www.hc-sc.gc.ca/english/iyh/products/crystal_lead.html 

Lead Information Package – Some Commonly Asked Questions About Lead and Human 

Health: 

http://www.hc-sc.gc.ca/ewh-semt/contaminants/lead-plomb/asked_questionsquestions_posees_e.html 

Effects of Lead on Human Health: 

http://www.hc-sc.gc.ca/english/iyh/environment/lead.html 
75 

For more information on product labels and symbols, consult Do You Know What These 

Symbols Mean? at http://www.hc-sc.gc.ca/cps-spc/pubs/cons/symbol_e.html or call Health 

Canada’s Information and Education Health Unit at (613) 952-1014. 

Household chemicals are safe if used and stored as recommended. Chemical products 

commonly found throughout the home include cleaning liquids and powders, polishers, drain 

cleaners, paint thinners and windshield washers. 

Use the following tips to keep your child safe from household chemicals: 

• Learn what the symbols and safety warnings on the labels of household chemicals mean. 

• Teach children that the symbols on product labels mean: DANGER! DO NOT TOUCH. 

• Read the label. If there is anything in the label instructions that you don’t understand, ask 

for help. 

• Make sure the labels on containers are not removed or covered up. 

• Lock all chemical products out of the sight and reach of children. Household chemical 

containers, even if sealed or empty, are not toys. Never let children play with them. 

• Close the cap on the container tightly, even if you set it down for just a moment. Make 

sure that child-resistant containers are working. Child-resistant does not mean childproof! 

• Keep household chemicals in their original containers. Never store chemicals in pop 

bottles or other food containers. 

• Never mix chemicals together. Some mixtures can produce harmful gases. Consider 

using non-toxic alternatives such as baking soda instead of commercial cleaning 

products. 

• Buy the smallest quantity of chemical products needed for the job. Unwanted portions 

should be disposed of at a hazardous waste depot. Contact your local municipal or 

county office for locations nearest you. 

If you suspect your child has swallowed a household chemical: 

• Call a Poison Control (Information) Centre immediately and seek 

medical attention. 

• Keep the phone number of the Poison Control (Information) Centre 

by the phone. 

• Phone numbers of Poison Control (Information) Centres can be 

found at the front of your local telephone directory. 

• When you call the Poison Control (Information) Centre, you need 

to know the name of the product, amount taken, and the time of 

the incident. 

Using Arts and Crafts Materials Safely 

The most common health hazards from working with arts and crafts materials are cuts from 

knives or scissors. However, there can be risks from a few of the materials themselves, such as 

some colourings and solvents. 

To help your child(ren) stay safe when doing arts and crafts: 

• Supervise children with arts and crafts materials. 

• Choose non-toxic products. 

• Always follow safety instructions given on the label. 

• Keep materials in their original containers so that you 

can refer to the label instructions every time they are 

used. 

• Store all arts and crafts materials that should be used 

under supervision out of the reach and sight of children. 
76 

• Do not allow children to eat or drink when using arts and crafts materials. 

• Do arts and crafts in a well-ventilated area. 

Some arts and crafts materials are never safe for children to use: 

• Paint that is not identified as non-toxic, ceramic glaze, copper enamel and solder for 

stained glass may contain lead or cadmium. 

• Shellac, paint strippers and craft dyes may contain solvents with toluene or methyl 

alcohol, which may cause blindness or other serious health effects if swallowed. Check 

the label for the ingredients of the product. 

For pregnant or breastfeeding women: 

• Do not work with solvents, lead compounds or dust-producing materials. If you are 

contemplating pregnancy or are pregnant consult your physician with respect to the 

effects of toxic arts materials. 

For further information, consult Arts and Crafts at http://www.hcsc.gc.ca/english/iyh/products/arts.html or call Health Canada at (613) 957-2991. 
77 

Appendix 3 Indicator Templates 

Note: No indicator templates are provided for indicators 4, 10 and 13. 

Indicator 1 - Percentage of children living in areas where air pollution levels 

exceed relevant air quality standards 

This specific indicator is currently not available in Canada.

Type of indicator: 

Exposure 

INDICATOR description 

Definition Figure 2.1. Average levels of several air pollutants in Canada, 1984–2002

Figure 2.2. Peak levels of ground-level ozone for selected regions of Canada, 

1989–2002

Figure 2.3. Number of days in 2002 on which ozone levels exceeded the Canadawide Standard 

Figure 2.4. Peak levels of fine particulate matter (PM2.5) for selected cities in 

Canada, 1984–2002

Figure 2.5. Number of days in 2002 on which PM2.5 levels exceeded the Canadawide Standard 

Rationale and role Ground-level ozone and airborne particles combine with other air pollutants to 

produce smog. Smog can affect our health by irritating the eyes, nose and throat, 

reducing lung capacity and aggravating respiratory or cardiac diseases. It has also 

been implicated in premature deaths. Especially vulnerable are the elderly, children 

and those with heart or lung disease. Recent studies suggest that there are no safe 

levels of human exposure to fine airborne particles and ground-level ozone. 

Data range • For volatile organic compounds (VOCs): 1991–2002 

• For nitrogen oxides (NOx), sulphur dioxide (SO2) and carbon monoxide (CO): 

1984–2002

• For ozone: 1989–2002 

• For PM2.5: 1984–2002 

Terms and concepts “Annual averages” of air pollutant levels measured in ambient air are derived by 

averaging the mean concentrations of air pollutants measured at each monitoring 

station for each year. 

Canada-wide Standards: In 1998, the Canadian Environment Ministers signed the 

Canada-wide Accord on Environmental Harmonization and its subagreement on 

Canada-wide Standards. Canada-wide Standards typically contain a numeric limit, a 

time frame for achievement and a framework for monitoring progress and reporting 

to the public. Air-related Canada-wide Standards exist for benzene, dioxins and 

furans, mercury, particulate matter (PM) and ground-level ozone. The Canada-wide 

Standards are: 

• Ground-level ozone: 65 ppb (8-hour averaging time, averaged over 3 years, to 

be attained by 2010) 

• PM2.5: 30 μg/m3

 (24-hour averaging time, averaged over 3 years, to be attained 

by 2010) 

Ground-level ozone is formed when NOx and VOCs react in sunlight. 

PM is one of the major components of smog. PM consists of microscopic particles 

in the air that are capable of being inhaled by humans and is divided into two size 

ranges: PM2.5 and PM<10. 

“Peak levels” of air pollutants are obtained by averaging the highest concentrations 

measured at each monitoring station for each year. 

Precursor air pollutants are CO, VOCs, SO2 and NOx. Precursor air pollutants 

contribute to the formation of smog. 

“Smog” has become a common term for urban air pollution. It contains two key 
78 

Indicator 1 - Percentage of children living in areas where air pollution levels 

exceed relevant air quality standards 

This specific indicator is currently not available in Canada.

Type of indicator: 

Exposure 

elements: fine airborne particles and ground-level ozone. 

Data sources, 

availability and quality 

Data are collected by the Federal/Provincial/Territorial National Air Pollution 

Surveillance (NAPS) network. NAPS air quality monitors collect real-time data and 

samples throughout Canada, particularly in urban areas. The number of monitors 

varies by pollutant type. NAPS network agencies’ quality assurance and quality 

control programs are supplemented by a federal quality assurance program. These 

programs ensure that the ambient air monitoring data collected from NAPS stations 

are valid, complete, comparable, representative and accurate. Elements of the 

network quality assurance program are site selection; sampling system 

requirements; site and analyzer operation; instrument calibration and reference 

standards; interlaboratory testing and performance audit program; data validation 

and reporting; documentation; and training and technical support. 

Contact: 

Paul Brunet 

Environmental Technology Centre 

Environment Canada 

(613) 991-9460 

Units of measurement • Parts per billion (ppb) for ground-level ozone, SO2, NOx and VOCs. 

• Parts per million (ppm) for CO. 

• Micrograms per cubic metre (μg/m3

) for PM2.5. 

Computation For levels of several air pollutants: VOCs, NOx and SOx are annual averages, while 

CO is the 98th percentile of the 8-hour averages, for all selected monitoring 

stations. Stations were included in the analysis if 70% of the years in the period had 

valid annual statistics. 

For peak levels of ground-level ozone: The selected stations were the ones having 

data for 70% of the years in the period. Valid annual statistics are based on the 

methodology outlined in the Guidance Document on Achievement Determination: 

Canada-wide Standards for Particulate Matter and Ozone. The yearly 4th highest 

daily maximum 8-hour ozone values for each station were averaged over 3 

consecutive years. The 3-year running average value for each station was then 

averaged for the region. 

For ozone exceedance days in 2002: Stations meeting the minimum data 

requirement based on the methodology outlined in the Guidance Document on 

Achievement Determination: Canada-wide Standards for Particulate Matter and 

Ozone were selected. The number of days on which the maximum 8-hour 

measurements exceeded 65 ppb were then summed for each station and plotted on 

the map of Canada. Values were used as is for sites meeting completeness criteria. 

For peak levels of PM2.5: Yearly PM2.5 values are the averages of the 98th 

percentile of 24-hour measurements for all available stations. Measurements were 

made by manual samplers (i.e., dichotomous samplers), which operate on a 1-in-6-

day schedule. A site was considered to have a valid year of data if at least 40 

measurements were available for the year and measurements were available in 

each quarter. Sites were also required to have 70% valid years of data in the period. 

For each year there were between 10 and 15 stations, located in commercial and 

residential areas of 10 cities, meeting these requirements. 

For PM2.5 exceedance days in 2002: Continuous samplers meeting the minimum 

data requirement based on the methodology outlined in the Guidance Document on 

Achievement Determination: Canada-wide Standards for Particulate Matter and 

Ozone were selected. The number of days on which the 24-hour measurements 

exceeded 30 μg/m3

 were then summed for each station and plotted on the map of 

Canada. 

Sources of further The NAPS Network website (and annual reports): http://www.etc-
79 

Indicator 1 - Percentage of children living in areas where air pollution levels 

exceed relevant air quality standards 

This specific indicator is currently not available in Canada.

Type of indicator: 

Exposure 

information cte.ec.gc.ca/NAPS/index_e.html 

Geographic scale Data are presented by individual monitoring stations for exceedance days, 

regionally for peak ground-level ozone and nationally for peak PM2.5 and for all 

precursor pollutants. 

Useful references Environmental Signals 2003: Canada’s National Environmental Indicators Series, 

urban air quality indicators: http://www.ec.gc.ca/soerree/English/Indicator_series/default.cfm

Environment Canada’s Air Quality Services website: http://www.mscsmc.ec.gc.ca/aq_smog/index_e.cfm 

Environment Canada’s Criteria Air Contaminant Emissions summaries: 

http://www.ec.gc.ca/pdb/ape/cape_home_e.cfm

Canadian Council of Ministers of the Environment: http://www.ccme.ca 

INDICATOR presentation and observations 

Data table(s) and 

chart(s) 

See graphs in section 2.1 of the Canada Country Report 

Key observations See text in section 2.1 of the Canada Country Report 

Strengths of the 

indicator 

• The indicators provide a clear national and regional overview of key trends in 

ambient levels of pollutants for Canada for the last 13–17 years. 

• Although reflecting only a single year, the exceedance maps show the spatial 

variability in PM and ozone and the number of days of high pollution levels. 

• The indicator covers most urban areas in Canada (except for peak PM2.5

average trend). 

Limitations of the 

indicator 

• The PM2.5 peak indicator represents only 10–15 urban stations and is not 

considered to be representative of Canada. This will be addressed in the future 

as more monitoring data become available. 

• Ambient air quality levels measured at a sampling station do not necessarily 

represent the exact levels to which the population is exposed in the 

surrounding areas. 

• The indicator does not link measured air quality levels with population numbers, 

to give an indication of how many children may be more at risk from poor air 

quality. 

• The indicators do not provide a measure of the potential combined health 

effects of exposure to multiple pollutants simultaneously. 

Additional indicators Criteria Air Contaminant Emissions Inventory: This inventory provides yearly 

estimates of total Canadian emissions for several air pollutants and their precursors 

(e.g., VOCs and ammonia). 

The NAPS network also monitors the ambient levels of several other substances, 

including toxic metals (such as arsenic, lead and mercury), 14 inorganic and organic 

anions and 11 inorganic cations. 

Opportunities for 

improvement 

• Methods could be developed to convert point NAPS data to areas of influence 

for a number of pollutants to estimate potential exposure on a geographic 

scale. 

• Methods could be developed for estimating the percentage of children living or 

commuting in these areas of potential concern: specifically, breaking down the 

population of children to small geographic units for inter-census years. 

• Health research on the effects of multiple pollutants could provide the basis for 

developing an index that would incorporate several pollutants simultaneously, 

while considering the possible cumulative, additive or synergistic effects. 
80 

Indicator 1 - Percentage of children living in areas where air pollution levels 

exceed relevant air quality standards 

This specific indicator is currently not available in Canada.

Type of indicator: 

Exposure 

• Indicators integrating health outcomes (e.g., hospital admissions, mortality) and 

ambient levels are under development and could provide more informative 

trends. 

Related 

programs/activities 

Many programs are in place at all levels of government to address problems related 

to air quality, including international agreements to reduce transboundary flow of 

emissions, air quality prediction programs, measures to make vehicles and fuel 

cleaner and regulations to reduce industrial emissions. See the Environment 

Canada Clean Air website for more details and links to sources of information: 

http://www.ec.gc.ca/air/being_done_e.html 
81 

Indicator 2 - Measure of children exposed to second-hand smoke Type of indicator: 

Exposure 

INDICATOR description 

Definition Percentage of children exposed to second-hand smoke in Canadian homes 

Rationale and role The health effects on children exposed to second-hand smoke include sudden 

infant death syndrome (SIDS) and breathing problems in children as young as 18 

months of age. Children exposed to second-hand smoke in their homes are more 

likely to suffer breathing problems such as asthma and damage to their lungs. 

Children are twice as likely to smoke if their parents are smokers. http://www.hcsc.gc.ca/hl-vs/tobac-tabac/second/fact-fait/index_e.html 

Data range Age groups: 0–5, 6–11, 12–14, 15–19 

Years: 1999, 2000, 2001, 2002 

Terms and concepts Second-hand smoke is a combination of poisonous gases, liquids and breathable 

particles that are harmful to our health. It consists of mainstream smoke, the smoke 

inhaled and exhaled by the smoker, and sidestream smoke, the smoke released 

directly from the end of a burning cigarette. Second-hand smoke contains over 4000 

chemical compounds, 50 of which are associated with or known to cause cancer. 

Two-thirds of the smoke from a burning cigarette is not inhaled by the smoker but 

enters into the surrounding environment. The contaminated air is inhaled by anyone 

in that area. Second-hand smoke has twice as much nicotine and tar as the smoke 

that smokers inhale. It also has five times the carbon monoxide, which decreases 

the amount of oxygen in our blood. Second-hand smoke causes disease and death 

in healthy non-smokers. Exposure for as little as 8–20 minutes causes physical 

reactions linked to heart and stroke disease: the heart rate increases; the heart’s 

oxygen supply decreases; and blood vessels constrict, which increases blood 

pressure and makes the heart work harder. If you are a non-smoker, exposure to 

second-hand smoke increases your chance of lung cancer by 25%, heart disease 

by 10% and cancer of the sinuses, brain, breast, uterine cervix and thyroid, as well 

as leukemia and lymphoma. Although only 3 in 10 people report being exposed to 

second-hand smoke, 9 in 10 people have detectable levels in their bodies. The test 

measures exposure that has occurred over the last 3 days. Second-hand smoke is 

a major source of indoor air pollution and the greatest source of air particle 

pollution. http://www.hc-sc.gc.ca/hl-vs/tobac-tabac/second/fact-fait/index_e.html

Data sources, 

availability and quality 

Canadian Tobacco Use Monitoring Surveys (CTUMS) 1999, 2000, 2001, 2002, 

Household Component 

E-mail: TCP-PLT-questions@hc-sc.gc.ca 

Units of measurement Percentage of children who are exposed at home to second-hand smoke by 

province and age group 

Computation Statistics Canada conducted computer-assisted interviews by telephone; only direct 

reports (i.e., not third-party) with selected persons were accepted. Information about 

household composition and second-hand smoke in the home was collected in 

43 973 households. In about half of those households, one person aged 15 or older 

was selected to obtain information on smoking habits. This amounted to 21 788 

individuals, about half of whom were aged 15–24. Further, to allow provincial 

comparisons of approximately equal reliability, the overall sample size for the 

survey was divided equally across all 10 Canadian provinces. Some topics were 

introduced in the questionnaire in July 2001, and the sample for these was 11 140. 

They include reasons for smoking light or mild cigarettes, views on public smoking, 

perceptions of the health effects of second-hand smoke, smoking restrictions at 

work and details about cessation. The overall response rate, which considers the 

participation of both households and individuals, was 77% for the 2001 CTUMS 

data collection. Every telephone number called by Statistics Canada was fully 

accounted for in order to calculate the survey’s response rate accurately and to 

properly weight the data to represent the Canadian population. 

Sources of further Microdata: A microdata set containing the results of the survey is available for 
82 

Indicator 2 - Measure of children exposed to second-hand smoke Type of indicator: 

Exposure 

information purchase from Statistics Canada. 

Geographic scale Population coverage: The target population for CTUMS is all persons aged 15 and 

older living in Canada, excluding residents of Yukon, Nunavut and the Northwest 

Territories and full-time residents of institutions. In addition, because this was a 

telephone survey, the 3% of Canadians without telephones are not included. 

Useful references http://www.hc-sc.gc.ca/hecs-sesc/tobacco/research/ctums/index.html 

INDICATOR presentation and observations 

Key observations Generally, the percentages of children (in all four age categories 0–5, 6–11, 12–14 

and 15–19) exposed to second-hand smoke in Canadian homes are decreasing. It 

is also evident that for all 4 years (1999–2002), exposure to second-hand smoke is 

highest among children aged 15–19 and lowest among those aged 0–5. Overall, in 

2002, 19% of children aged 0–17 were regularly exposed to second-hand smoke in 

the home. 

Strengths of the 

indicator 

The indicator is nationally and regionally relevant. 

Limitations of the 

indicator 

It does not consider the degree to which those over 15 years of age smoke in the 

home and what protection measures (e.g., filters) may be in place. It does not 

consider exposure of the fetus. 

Additional indicators Exposure of fetuses. Number of children who smoke. 

Opportunities for 

improvement 

Biomonitoring of the levels of contaminants in the blood of children who live in 

homes with smokers. 

Related 

programs/activities 

Health Canada’s website includes information for youth related to smoking entitled 

“You and Me Smokefree”: http://www.hc-sc.gc.ca/hecssesc/tobacco/youth/index.html
83 

Supplementary Tables, CTUMS Annual 2002 

Table 11: Exposure of children at home to environmental tobacco smoke, by province and age 

group, Canada, 2002 

Province % of children age 0–11 

regularly exposed 

% of children age 12–17 

regularly exposed 

% of children age 0–17 

regularly exposed 

Canada 16 23 19 

 

Newfoundland and 

Labrador 

21 29 24 

Prince Edward Island 17 24 20 

Nova Scotia 21 24 22 

New Brunswick 18 26 21 

Quebec 26 36 29 

Ontario 12 18 14 

Manitoba 17 25 20 

Saskatchewan 18 28 22 

Alberta 15 21 17 

British Columbia 6 14 9 

Estimates may not sum to 100% due to rounding. Source: Canadian Tobacco Use Monitoring Survey, 

Household Component, February–December 2002, available at: http://www.hc-sc.gc.ca/hl-vs/tobactabac/research-recherche/stat/ctums-esutc/index_e.html 
84 

Indicator 3 - Prevalence of asthma in children Type of indicator: 

Health outcome 

INDICATOR description 

Definition Prevalence of physician-diagnosed asthma 

Rationale and role Exposures to indoor and outdoor sources of biological and chemical environmental 

contaminants have been shown to cause asthma or exacerbate existing asthma. 

Data range Children in two age groups: 4–7, 8–11. For the years 1994–95, 1996–97 and 1998–

99. 

Terms and concepts Asthma is characterized by cough, shortness of breath, chest tightness and 

wheeze. Asthma symptoms and attacks (episodes of more severe shortness of 

breath) usually occur after exposure to allergens, viral respiratory infections 

(“colds”), exercise or exposure to irritant fumes or gases. These exposures cause 

both an inflammation of the airway wall and abnormal narrowing of the airways, 

which lead to asthma symptoms. Avoiding triggers, environmental control and 

preventive treatment can reduce symptoms, and treatment medication can control 

symptoms once they occur. Asthma is one of the most prevalent chronic conditions 

in Canadian children and is also a serious problem in adults. Asthma imposes a 

heavy burden on the nation’s health care expenditures and reduces the quality of 

life for individuals with asthma and their families. 

Data sources, 

availability and quality 

National Longitudinal Survey of Children and Youth (NLSCY), Statistics Canada: 

http://www.statcan.ca/english/sdds/4450.htm 

Units of measurement Percentage of children whose parents indicated that their child(ren) had ever been 

diagnosed with asthma by a physician 

Computation The NLSCY is a long-term study, the primary objective of which is to monitor the 

development and well-being of Canada’s children from infancy to adulthood. It 

follows a representative sample of Canadian children from birth to 11 years of age,

with data collection occurring at 2-year intervals beginning in the winter and spring 

of 1994–95. Much of the information in the NLSCY, including the information 

relevant to asthma, is collected from parents on behalf of their children by means of 

a household interview. Several frames were used to select the initial sample. 

Households with children in the target population (ages 0–11) were selected from 

the old-design Labour Force Survey (LFS), from the new-design LFS and from the 

National Population Health Survey (NPHS) both outside and inside Quebec. A total 

of 22 831 responding children made up the longitudinal sample in 1994–95. The 

sample size was 16 903 in 1996–97 and 16 718 in 1998–99. 

Sources of further 

information 

Statistics Canada, Social Development Canada 

Geographic scale The indicator is intended to be nationally relevant. The objective of the NLSCY is to 

produce reliable provincial estimates by age group. 

Useful references More information about this indicator is available on the following website, which 

includes additional facts and figures related to asthma: http://www.phacaspc.gc.ca/ccdpc-cpcmc/crd-mrc/facts_asthma_e.html

INDICATOR presentation and observations 

Key observations Since 1994, asthma prevalence has been increasing among children (except boys 

aged 4–7 years). Boys of all ages have a higher prevalence of asthma than girls. 

Currently, approximately 20% of boys aged 8–11 have been diagnosed with 

asthma, the highest prevalence group among children. More research is required to 

better understand the causes of asthma, the reasons for the increased prevalence 

of asthma and the relationship between environmental factors and asthma. 

Strengths of the 

indicator 

It is nationally and regionally significant. 

Limitations of the 

indicator 

It is difficult to quantify the link between the environment and the prevalence of 

asthma. There are contributing factors to asthma prevalence other than 
85 

Indicator 3 - Prevalence of asthma in children Type of indicator: 

Health outcome 

environmental factors (e.g., predisposing factors). “Prevalence” is the number of 

people in the population who have a condition at a specific point in time. “Incidence” 

is the number of new people who develop the condition during a specific time 

period. Each measure provides valuable information on the population. Canada 

does not currently have incidence data, so we must rely on prevalence data. 

Additional indicators Additional indicators could include asthma hospitalization rates, asthma deaths and 

asthma mortality rates. See: 

http://www.phac-aspc.gc.ca/publicat/rdc-mrc01/index.html#figures 

or 

http://www.phac-aspc.gc.ca/publicat/pma-pca00/index.html

Opportunities for 

improvement 

More children could be included and assessed at greater frequency. Efforts could 

be made to distinguish environmental contributors to asthma from others. 

Related 

programs/activities 

The federal government, working with its partners through the Chronic Respiratory 

Diseases Program of the Centre for Chronic Disease Prevention and Control 

(Health Canada), has, as its mission, to bring about effective preventive and control 

measures to reduce suffering, disability and death due to chronic respiratory 

diseases in Canada. Strategies, programs and projects include: 

• Surveillance: Coordination of national surveillance on chronic respiratory 

disease; report on “Respiratory Disease in Canada” every 3 years; website with 

up-to-date data. 

• Population-based research using national databases: Research using NPHS, 

Canadian Community Health Survey (Statistics Canada), Hospitalization 

Database (Canadian Institute for Health Information), Mortality Database 

(Statistics Canada), Special Surveys. 

• Prevention and control of asthma: National strategic plan; member of Canadian 

Network for Asthma Care; assistance with resource development; policy and 

guidelines development; interpretation of research literature reviews; building 

capacity for prevention and control initiatives. 

• Prevention and control of chronic obstructive pulmonary disease (COPD):

National strategic plan; member of Canadian COPD Alliance; assistance with 

resource development; policy and guidelines development; interpretation of 

research literature reviews; building capacity for prevention and control 

initiatives. 

• Information dissemination: Respond to internal and external requests for data 

and information. 

More information is provided by Health Canada’s Centre for Chronic Disease 

Prevention and Control: http://www.phac-aspc.gc.ca/ccdpc-cpcmc/crdmrc/asthma_e.html and http://www.phac-aspc.gc.ca/ccdpc-cpcmc/topics/crdasthma_e.html
86 

Indicator 5 - Children living in homes with a potential source of lead Type of indicator: 

Exposure surrogate 

INDICATOR description 

Definition Children aged 0–19, living in housing stock built before 1960, are aggregated for the 

Census years 1991, 1996 and 2001. 

Rationale and role Most indoor and outdoor paints produced before 1960 contained substantial 

amounts of lead. Children are believed not to be at risk from lead in paint unless it is 

disturbed (e.g., during renovations) or if they chew on surfaces painted with leadbased paint. Indoor lead levels tend to increase while houses are being renovated, 

particularly if the renovation involves electric sanding or burning with a blow lamp 

(Laxen et al., 1988; Davies et al., 1990). 

Data range For the Census years 1991, 1996 and 2001. Four age groups were selected for 

children: 0–4, 5–9, 10–14, 15–19. 

Data sources, 

availability and quality 

The data are from Statistics Canada, Census of Population, 1991, 1996, 2001. 

Units of measurement The number of children 0–4, 5–9, 10–14 and 15–19 living in houses built before 

1960 

Computation The charts are compiled from Census of Population counts cross-tabulated by age 

and period of construction. Data were extracted from the main Statistics Canada 

population databases. The data were then processed in Excel to develop the final 

indicator. 

Rationale for the selection of the 1960 threshold

Homes built before 1960 were likely painted with lead-based paint. Paints before 

1950 contained large amounts of lead. Some paint made in the 1940s contained up 

to 50% lead by dry weight. During the 1950s, lead was used more commonly in 

exterior paint but was still used in the interiors of homes. In Canada, the Liquid 

Coating Materials Regulations were enacted under the Hazardous Products Act in 

1976 to restrict the amount of lead in paints and other liquid coatings on furniture, 

household products, children’s products and exterior and interior surfaces of any 

building frequented by children to 0.5% by weight. By the end of 2002, the amount 

of lead in paint was restricted to 0.06% by weight. 

Sources of further 

information

Data providers: Statistics Canada, Canadian Mortgage and Housing Corporation 

Indicator developers: Health Canada/Environment Canada 

Scale of application The data have been compiled nationally for the indicators report. 

Useful references Please see Table 1 and Figure 1 of Wigle (2003). 

INDICATOR presentation and observations 

Key observations In 2001, 24% of Canadian children under 5 years of age lived in housing built prior 

to 1960. The number of children in the four age categories (<5, 5–9, 10–14 and 15–

19) living in homes built prior to 1960 declined slightly between 1991 and 2001.This 

indicator measures only the potential for exposure to lead in the home. 

The slow retirement of old housing stock may have contributed to the decline 

observed. 

Concentrations of lead in the environment increased following the introduction of 

lead additives in automobile gasoline. Then, between 1973 and 1985, airborne lead 

concentrations fell considerably due to the increased use of unleaded gasoline. 

Since 1990, the use of leaded gasoline in on-road motor vehicles has been 

prohibited in Canada, under the Canadian Environmental Protection Act (CEPA). 

Although leaded gasoline is no longer used in such vehicles in Canada, lead 

particles from gasoline emissions are still a source of lead in our environment today. 

In addition, leaded gasoline is still being used in many countries, so contamination 

of the atmosphere continues. 
87 

Indicator 5 - Children living in homes with a potential source of lead Type of indicator: 

Exposure surrogate 

Strengths of the 

indicator 

Nationally relevant. Focuses on the major source of exposure for children in 

Canada. 

Limitations of the 

indicator 

Because children are believed not to be at risk from lead in paint until it is disturbed, 

the relationship between lead in paint in homes and actual exposure is not reflected 

in this indicator. There may also be other sources for lead in house dust posing 

risks to children’s health that are not taken into account in this indicator. 

Additional indicators Blood lead measures would be ideal. Currently, they are not available on a 

nationally representative sample of Canadian children. 

Opportunities for 

improvement 

Include health exposure data from lead found in the soil, dust, drinking water, food 

and various consumer products. Measure blood lead levels in children. 

Related 

programs/activities 

Health Canada is mandated, under the Government of Canada’s Hazardous 

Products Act and Regulations, to protect Canadians from potential health hazards in 

consumer products. Health Canada has also developed a Lead Risk Reduction 

Strategy for Consumer Products to protect children from exposure to lead through 

consumer products. It proposes to regulate children from exposure to lead through 

consumer products. The Food and Drugs Act controls the lead content in food and 

food packaging materials such as tin cans. 
88 

Indicators 6 and 7 - PRTR data on industrial releases of lead / PRTR data on industrial 

releases of 153 chemicals

Type of indicator: 

Action 

INDICATOR description 

Definition The indicator uses data from pollutant release and transfer registries (PRTRs) as an 

action indicator, to determine governments’ and industry’s effectiveness in reducing 

emissions of various chemicals released by facilities into all environmental media (air, 

water, land and injected underground). PRTRs are central national registries that are 

designed to provide detailed data on types, locations and amounts of chemicals that are 

released into air, water or land or that are transferred off-site for further management or 

disposal by industrial facilities. The data are collected by national governments each year 

and compiled into annual reports and electronic databases. PRTRs have been 

established both in Canada and the United States and voluntarily in Mexico. 

Rationale and role The role of this indicator is to serve as an action indicator by providing trends in release 

data from major industrial and commercial sources for selected chemicals. The selected 

chemicals are those that are required by governments to be reported to national (both 

U.S. and Canadian) registries. Those chemicals reported to national registries are a very 

small subset of all chemicals emitted to the environment every year. Trends in pollutant 

releases allow the determination of whether “actions” taken by governments and industry 

to reduce pollutant releases to the environment are effective. 

National registries of releases and disposal of chemicals provide information to the public 

on the sources, handling and quantities of hundreds of chemicals released into the 

environment. PRTRs are valuable tools that allow us to set better priorities and targets, 

manage releases and track progress. 

The PRTR data are annual estimates of emissions to the environment. For chemicals that 

persist a long time in the environment, bioaccumulate and travel far from their points of 

origin, these ongoing annual releases are of particular concern, because they add to the 

cumulative load of chemicals to the environment. PRTR data are just one source of 

information on toxic chemicals in the environment. Other sources include measurements 

of concentrations of chemicals in the air, land and water in our communities, specialized 

chemical and air pollutant inventories, hazardous waste databases, modelling estimates, 

body burdens in plants, fish and people, and industrial emission rates for chemicals. 

In making good use of PRTR data, it is important to know their limitations. PRTR data do 

not include: 

• all potentially harmful chemicals—just those on the lists of chemicals to be reported; 

• chemicals released from mobile sources, such as cars and trucks; 

• chemicals released from natural sources, such as forest fires and erosion; 

• chemicals released from small sources, such as dry cleaners and gas stations; 

• chemicals released from small manufacturing facilities with fewer than 10 employees; 

• information on the toxicity or potential health effects of chemicals; 

• information on risks from chemicals released or transferred; or 

• information on exposures of humans or the environment to chemicals released or 

transferred. 

From a children’s health perspective, the rationale for providing an action indicator of 

PRTR data is that industrial emissions of these chemicals may contribute to the 

contamination of the food children eat, the water they drink, the air they breathe and the 

soil with which they come in contact. In addition, certain subpopulations of children may 

be exposed to pollutant releases to air, water and soil. PRTR data represent estimated 

releases of pollutants to the environment and do not represent human exposure to these 

substances. The degree of human exposure is not necessarily proportional to the number 

of tonnes of pollutants released. There are many factors to consider in determining 

human exposure to each chemical and the risks associated with that exposure. These 

include: 
89 

Indicators 6 and 7 - PRTR data on industrial releases of lead / PRTR data on industrial 

releases of 153 chemicals

Type of indicator: 

Action 

• the route of exposure (ingestion, inhalation, dermal); 

• the duration and frequency of the exposure; 

• the rate of uptake of the substance; 

• the individual age, gender and ethnicity; and 

• the disease, overall health and nutritional status of the individual (including pregnancy 

status, in the case of prenatal exposure). 

PRTR data for Canada are provided by the National Pollutant Release Inventory (NPRI), 

which is a legislated, nationwide, publicly accessible inventory of pollutants released to 

the environment. It was created in 1992 to provide Canadians with information on 

pollutant releases to air, water and land from facilities located in their communities and the 

quantities sent to other facilities for disposal, treatment or recycling. For the 2001 

reporting year, there were 274 substances listed in the NPRI. 

Using NPRI data, Canada is reporting: 

• Under Industrial Releases of Lead – Indicator 6 PRTR data on industrial releases of 

lead: 

Figure 3.3: On- and off-site releases of lead (and its compounds), Canada, 1995–2000 

Figure 3.4: Total estimated emissions of lead to air, Canada, 1990–2002 

• Under Industrial Releases of Selected Chemicals – Indicator 7 PRTR data on 

industrial releases of 153 chemicals 

Figure 3.5: Total on- and off-site releases of matched chemicals, Canada, 1998–2002 

Figure 3.6: Total on- and off-site releases of matched chemicals, by industry sector, 

Canada, 1998–2002

Figures 3.7–3.13: On-site releases of selected toxic substances reported in the NPRI for 

Canada

Figure 3.14: Total atmospheric releases of mercury in Canada, 1990–2000 

In order to increase comparability of data, the Commission for Environmental Cooperation 

(CEC) Steering Group decided to report PRTR data for 153 matched chemicals—those 

chemicals reported in the NPRI that are also required to be reported in the United States 

(Figures 3.5 and 3.6). 

In addition, emissions data are presented separately for 7 of the 274 chemicals reported 

to the NPRI (Figures 3.7–3.13). Those chemicals were selected due to the health effects 

associated with potential children’s exposure to them. The chemicals selected are 

arsenic, benzene, cadmium, chromium, dioxins and furans, hexachlorobenzene (HCB)

and mercury. 

Exposure can take place through inhalation of the chemical in the air (indoors or 

outdoors), dermal contact with contaminated soil and ingestion of contaminated food, 

water or small amounts of soil. Each substance is associated with specific health effects 

in children, including cancer, birth defects or disruption of reproductive, developmental, 

neurobehavioural, immune system, endocrine and metabolic processes. 

The eight substances selected are not intended to be a comprehensive list of substances 

that are of specific concern to children’s health. Rather, they are a few substances for 

which there are known adverse health effects in childhood or adulthood associated with 

prenatal or childhood exposure. This is Canada’s first attempt at prioritizing a vast amount 

of PRTR data from a children’s health perspective. 

Data range Emissions are reported from 1994 to 2002 except for dioxins and furans (2000–2002) and 

HCB (2000–2002), because those substances have been required to be reported to the 

NPRI since the year 2000 only. 

In addition, an inventory of total atmospheric releases of mercury is presented for 1990–

2000.

Terms and concepts The “153 matched chemicals” are those chemicals reported in the Canadian NPRI as well 
90 

Indicators 6 and 7 - PRTR data on industrial releases of lead / PRTR data on industrial 

releases of 153 chemicals

Type of indicator: 

Action 

as the U.S. Toxics Release Inventory (TRI). 

On-site releases: An on-site release is a discharge of an NPRI-listed pollutant to the 

environment, within the physical boundaries of the facility. This includes: 

• emissions to the air (discharges through a stack, vent or other point release, losses 

from storage and handling of materials, fugitive emissions, spills and accidental 

releases, and other non-point releases); 

• releases to surface waters (discharges, spills and leaks, but not including discharges 

to municipal wastewater treatment plants, which are reported under off-site transfers 

for treatment); and 

• releases to land (spills, leaks and others). 

Off-site transfers for treatment prior to final disposal: A shipment of an NPRI-listed 

substance may be transferred to an off-site location for treatment prior to final disposal. 

The treatment processes include: 

• physical treatment (e.g., drying, evaporation, encapsulation or vitrification); 

• chemical treatment (e.g., precipitation, stabilization or neutralization); 

• biological treatment (e.g., bio-oxidation); 

• incineration or thermal treatment where energy is not recovered; and 

• treatment at a municipal sewage treatment plant. 

Off-site transfers for recycling and energy recovery: A shipment of an NPRI-listed 

substance may be transferred to an off-site location for recycling and energy recovery. 

“Recycling” refers to activities that keep a material or a component of the material from 

becoming a waste destined for final disposal. Nine types of recycling operations are 

identified: 

• recovery of solvents; 

• recovery of organic substances (other than solvents); 

• recovery of metals and metal compounds; 

• recovery of inorganic materials (other than metals); 

• recovery of acids and bases; 

• recovery of catalysts; 

• recovery of pollution abatement residues; 

• refining or reuse of used oil; and 

• other recovery, reuse or recycling activities. 

Reporting thresholds: Only facilities that emit a chemical in a quantity above the reporting 

threshold are required to report the emission of that chemical to the NPRI. Prior to 2000, a 

facility was generally required to report releases and transfers of an NPRI-listed chemical 

if that chemical was manufactured, processed or otherwise used in a quantity exceeding 

10 tonnes per year at a concentration equal to or greater than 1% by weight and byproducts at any concentration. 

Reporting thresholds for some chemicals were lowered in 2002. Lowering of the reporting 

thresholds increases the number of facilities that are required to report and thus may 

result in increases in reported emissions. Such reported increases may not necessarily 

reflect an increase in emissions to the environment. 

In addition, even under a constant reporting threshold, the number of facilities reporting 

from year to year may still fluctuate, depending on whether their emissions were higher or 

lower than the reporting threshold for each particular year. 

Reporting thresholds for each chemical reported for these two indicators are as follows: 

1. Arsenic: From 1994 to 2001: 10 tonnes; for year 2002: 50 kg with a 0.1% concentration 

threshold. 
91 

Indicators 6 and 7 - PRTR data on industrial releases of lead / PRTR data on industrial 

releases of 153 chemicals

Type of indicator: 

Action 

In the year 2000, the 20 000-hour employee threshold was removed for certain industries, 

including wood preservation, a source of arsenic releases. 

2. Benzene: 10 tonnes with a 1% concentration threshold. 

3. Cadmium: From 1994 to 2001: 10 tonnes with a 1% concentration threshold; for year 

2002, reporting threshold changed to 5 kg with a 0.1% concentration. 

4. Chromium (and its compounds): 10 tonnes with a 1% concentration threshold; 

beginning in 2002, the reporting of hexavalent chromium (the most toxic form of chromium 

compounds) is reported separately in the NPRI. 

5. Dioxins and furans and 6. HCB: Reported on an “activity-based” threshold basis. 

Facilities engaged in some identified activities (“activity-based threshold”) are required to 

submit a report on dioxins and furans and HCB to the NPRI. The identified activities were 

selected by Environment Canada to cover all main point sources of dioxins/furans and 

HCB releases being targeted by Canada-wide Standards initiatives for dioxins/furans and 

HCB. Reporting by limited sectors known to release these substances will capture all 

significant releases from such facilities, while minimizing reporting burden on other NPRI 

reporting facilities. 

7. Lead: 50 kg with a 0.1% concentration threshold. 

8. Mercury: From 1994 to 1999: reporting threshold at 10 tonnes; from 2000 to 2002: 

reporting threshold at 5 kg at with no concentration limit. 

Data sources, 

availability and quality 

Data source: Data are provided by the NPRI. The NPRI is a legislated, nationwide, 

publicly accessible inventory of pollutants released to the environment. It was created in 

1992 to provide Canadians with information on pollutant releases to air, water and land 

from facilities located in their communities and the quantities sent to other facilities for 

disposal, treatment or recycling. The NPRI program is delivered by Environment Canada 

under the authority of the Canadian Environmental Protection Act, 1999 (CEPA 1999). 

Owners or operators of facilities that meet the criteria for reporting for one or more of the 

listed substances are required to submit an annual report to Environment Canada on the 

releases and transfers of those substances. The NPRI list of substances was developed 

through public consultation and includes substances of health or environmental concern.

Environment Canada makes the information available to Canadians in an annual public 

report and maintains a detailed inventory that can be accessed and searched through an 

online database (http://www.ec.gc.ca/pdb/npri/).

Data quality: Amounts reported to the NPRI are estimates. These estimates may reflect 

monitoring, engineering calculations, emission factors (which identify the amounts of a 

chemical that can be expected to result from particular industrial processes or from use of 

specific equipment) or other estimation techniques. The NPRI requires reporting of the 

amounts of individual types of transfers. The data collected from the facilities are reviewed 

for inconsistencies by staff in the NPRI office, and then the data are posted on the NPRI 

website for public access.

Units of measurement The units of measurement are tonnes, grams (for HCB) and grams of international toxicity 

equivalent (TEQ) (for dioxins and furans). 

Computation Figure 3.3: On- and off-site releases of lead (and its compounds), Canada, 1995–

2000 

Only manufacturing industries were selected, which does not include electric utilities, 

hazardous waste facilities or mining facilities. 

Manufacturing Industry Sectors (U.S. SIC codes 20–39) include Food Products, Tobacco 

Products, Textile Mill Products, Apparel and Other Textile Products, Lumber and Wood 

Products, Furniture and Fixtures, Paper Products, Printing and Publishing, Chemicals, 

Petroleum and Coal Products, Rubber and Plastics Products, Leather Products, 

Stone/Clay/Glass Products, Primary Metals, Fabricated Metals Products, Industrial 

Machinery, Electronic/Electrical Equipment, Transportation Equipment, 

Measurement/Photographic Instruments, Misc. Manufacturing Industries. 

Figure 3.4: Total estimated emissions of lead to air, Canada, 1990–2002 
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Numerous data sources were used to compile Canada’s comprehensive atmospheric lead 

emissions inventory, including the NPRI. Estimation methods are done according to the 

EMEP/CORINAIR Emission Inventory Guidebook 

(http://reports.eea.eu.int/EMEPCORINAIR3/en/tab_abstract_RLR) prepared by the United 

Nations Economic Commission for Europe (UNECE)/EMEP Task Force on Emissions 

Inventories and Projections. 

Figures 3.5 and 3.6 

See the CEC Taking Stock 2001 report for a complete list of the 153 matched substances 

included in these figures (http://www.cec.org/takingstock/). 

Only certain industry sectors are covered in the matched data set: 

Manufacturing Industry Sectors (U.S. SIC codes 20–39): Food Products, Tobacco 

Products, Textile Mill Products, Apparel and Other Textile Products, Lumber and Wood 

Products, Furniture and Fixtures, Paper Products, Printing and Publishing, Chemicals, 

Petroleum and Coal Products, Rubber and Plastics Products, Leather Products, 

Stone/Clay/Glass Products, Primary Metals, Fabricated Metals Products, Industrial 

Machinery, Electronic/Electrical Equipment, Transportation Equipment, 

Measurement/Photographic Instruments, Misc. Manufacturing Industries. 

Other Sectors: Coal Mining (except U.S. SIC code 1241), Electric Utilities (limited to those 

that combust coal and/or oil, U.S. SIC codes 4911, 4931 and 4939), Hazardous Waste 

Treatment and Disposal/Solvent Recovery (U.S. SIC codes 4953 and 7389), Chemical 

Wholesalers. 

* U.S. SIC codes are used because NPRI facilities report both the Canadian SIC code 

and the equivalent U.S. SIC code and TRI facilities report only the U.S. SIC codes. 

The data for this indicator were extracted from the NPRI database and then processed in 

Excel. The units for some of the substances have been converted to more appropriate 

units, such as kilograms or grams. The indicator is the sum of reported releases to air, 

water and land. 

Figures 3.7–3.13: On-site releases to air, water and soil of selected toxic 

substances reported in the NPRI for Canada 

On-site releases on selected substances as reported in the NPRI, all sectors. 

Figure 3.14: Total atmospheric releases of mercury in Canada, 1990–2000 

Numerous data sources were used to compile Canada’s comprehensive atmospheric 

mercury emissions inventory. About 73% of the emissions were obtained from Canada’s 

PRTR program, the NPRI. The NPRI-reported emissions are based on a variety of 

estimation methods, predominantly emission factors, and stack testing. To complete the 

inventory, a variety of statistics, databases, methodologies and submissions were used. 

Statistics from Statistics Canada, such as fuel use, were the major source of data for the 

area source calculations, but other information was obtained from various industrial sector 

associations (e.g., pulp and paper, electrical utilities), provincial authorities and 

government departments to estimate the emissions. 

Databases such as the Canadian Residual Discharge Information System II, which 

contains facility-specific information, were used in conjunction with emission factors from 

the U.S. Environmental Protection Agency emission factor database FIRE 6.23, AP-42 

emission factor manuals, mercury locating and estimating documents, and numerous 

other documents. For some of the sectors, Environment Canada has performed surveys 

(e.g., residential firewood) or used consultants’ reports to complete the emissions picture. 

Industrial/commercial sectors were analyzed to ensure comprehensiveness. Values for 

those facilities/sectors that did not report mercury emissions were estimated by 

Environment Canada. 

The mercury emissions inventory is for anthropogenic activities in that year. Emissions 

that are due to historical activities are not included, nor are natural mercury emissions 

sources such as soil evasion or geological releases. 

The comprehensive mercury inventory includes emissions to air only (Environment 

Canada, 2003b). 
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Sources of further 

information 

Data providers: 

Environment Canada 

National Pollutant Release Inventory 

Environment Canada 

9th Floor, Place Vincent Massey 

351 St. Joseph Blvd. 

Gatineau, Quebec 

K1A 0H3 

Tel.: (819) 953-1656 

Fax: (819) 994-3266 

E-mail: npri@ec.gc.ca

http://www.ec.gc.ca/pdb/npri 

Air Pollutant Emission Inventories: http://www.ec.gc.ca/pdb/ape/cape_home_e.cfm 

Indicator developers: 

National Indicators and Reporting Office, Environment Canada 

Environmental Signals: http://www.ec.gc.ca/soer-ree/English/Indicator_series/default.cfm 

CEC, Taking Stock reports: http://www.cec.org 

NPRI Office, Environment Canada 

NPRI: http://www.ec.gc.ca/pdb/npri 

Data users: 

Non-governmental organizations (e.g., PollutionWatch, 

http://www.pollutionwatch.org/home.jsp; CEC, Taking Stock reports, http://www.cec.org) 

Geographic scale National (all of Canada). The data are collected for individual facilities and can be 

expressed at different scales (e.g., by province). 

Useful references • NPRI website, which includes downloadable databases and annual reports: 

http://www.ec.gc.ca/pdb/npri 

• Online data search: http://www.ec.gc.ca/pdb/npri/npri_online_data_e.cfm 

• General inquiries: npri@ec.gc.ca 

• Environment Canada’s Environmental Signals, Canada’s National Environmental 

Indicator Series 2003: http://www.ec.gc.ca/soerree/English/Indicator_series/default.cfm 

INDICATOR presentation and observations 

Key observations NPRI “on-site” releases and transfers:

1. Arsenic 

Health effects

Inorganic arsenic has been consistently demonstrated in numerous studies to cause 

cancer in humans exposed by both inhalation and ingestion (Government of Canada, 

1993a). Food, drinking water and soil are the main potential sources of arsenic exposure 

for children. Inorganic arsenic crosses the human placenta, but there has been little 

research on adverse developmental outcomes. Ecological and case–control studies have 

shown elevated risks of spontaneous abortion, birth defects and/or stillbirths in areas with 

elevated drinking water or airborne arsenic levels. Prenatal exposure to high doses of 

inorganic arsenic caused neural tube defects, growth retardation and fetal death in 

hamsters, mice, rats and rabbits. The U.S. National Research Council and the Agency for 

Toxic Substances and Disease Registry concluded that there is insufficient evidence to 

judge if inorganic arsenic can affect reproduction or development in humans (Wigle, 2003: 

118). 

Trends in emissions
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Arsenic is a naturally occurring element found commonly in wood preservation industries, 

mining and fossil fuel combustion. Total on-site releases of arsenic increased slightly, by 

11.4%, from 180 tonnes in 1994 to 201 tonnes in 2002. Much of the increase in total onsite releases of arsenic, which include emissions to air and releases to land and water, 

can be accounted for by an almost fivefold increase in reporting facilities. In the year 

2002, there were 207 facilities reporting to the NPRI for arsenic, compared with only 46 in 

1994. Arsenic releases were at their lowest in 1995, with 108.8 tonnes, and at their 

highest in 2001, with 256.3 tonnes. 

Some important changes to NPRI reporting guidelines with respect to arsenic releases 

occurred in 2000 and 2002. In the year 2000, the 20 000-hour employee threshold was 

removed for certain industries, including wood preservation, a source of arsenic releases, 

while in 2002, arsenic thresholds were decreased from 10 tonnes to 50 kg at 0.1% 

concentration. 

Legislative and policy framework

Arsenic and its compounds were on the first Priority Substances List under the Canadian 

Environmental Protection Act (CEPA). The assessment concluded that current 

concentrations of inorganic arsenic in Canada may be harmful to the environment and 

may constitute a danger in Canada to human life and health. Inorganic arsenic 

compounds are listed as toxic in Schedule 1 of CEPA 1999. 

Currently, there are a number of regulations in place regarding arsenic releases on a 

federal level to reduce exposure. CEPA 1999 regulates the dumping at sea of any 

materials containing specified concentrations of arsenic. The federal government is also 

developing controls to reduce environmental exposure. 

In addition to CEPA 1999, section 36 of the federal Fisheries Act prohibits the depositing 

of harmful substances, including arsenic, into waters used by fish. The Metal Mining 

Liquid Effluent Regulations under the Fisheries Act also placed limits on arsenic and other 

metals found in mining effluents. The shipping or transport of arsenic under the federal 

Transportation of Dangerous Goods Act is controlled by the Hazardous Products Act, the 

Food and Drugs Act and the Pest Control Products Act. 

Environment Canada has also published technical guidelines for the safe design and 

operation of facilities that use arsenic. Guidelines and codes of practice that were 

developed to reduce the releases of arsenic include the following: 

• New Source Emission Guidelines for Thermal Electricity Generation 

• Environmental Code of Practice for Integrated Steel Mills 

• Environmental Code of Practice for Non-Integrated Steel Mills 

• Recommendations for the Design and Operation of Wood Preservation Facilities 

2. Benzene 

Health effects

Vehicle emissions are the major source of benzene releases to the environment. 

Releases of benzene result in measurable concentrations in the various media to which 

humans and other organisms may be exposed. In Canada, the primary source of human 

exposure to benzene is ambient and indoor air; food and drinking water contribute only 

minor amounts to the daily intake of benzene. Benzene has been demonstrated to cause 

cancer in experimental animals and humans. Benzene is, therefore, considered to be a 

“non-threshold toxicant”—i.e., a substance for which there is believed to be some chance 

of adverse effects at any level of exposure (Government of Canada, 1993b). Exposure to 

benzene causes leukemia and probably causes multiple myeloma (Etzel, 2003: 283). 

Trends in emissions

Total on-site releases of benzene have been decreasing steadily since 1994, while the 

number of reporting facilities has increased. In 1994, 2608 tonnes of benzene were 

released, while in 2002, 863 tonnes were released—representing a 67% decrease in 

benzene releases. These are significant decreases in on-site releases, as the number of 
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reporting facilities has been steadily increasing since 1994. There were 95 reporting 

facilities in 1994 compared with 204 reporting facilities in 2002, over a twofold increase. 

Benzene is currently one of 60 VOCs with additional reporting criteria in which the 

reporting of benzene releases is required only if the 10-tonne air release threshold for 

VOCs has been met. Some major sources of benzene and other VOCs, particularly in 

urban areas, include vehicle emissions, gasoline storage tanks, petroleum and chemical 

industries, dry cleaning, fireplaces, natural gas combustion and aircraft. On-site releases 

of benzene are decreasing in part due to the regulatory and non-regulatory tools that are 

used to reduce benzene releases in Canada. 

Legislative and policy framework

Benzene is listed as toxic under Schedule 1 of CEPA 1999. A major contributor to the 

decrease in releases thus far has been the federal government’s Benzene in Gasoline 

Regulations, which came into effect on July 1, 1999, by recommendation of the federal–

provincial Task Force on Cleaner Vehicles and Fuels. This regulation prohibits the supply 

after July 1, 1999, of gasoline that contains benzene at a concentration exceeding 1.0% 

by volume. It also prohibits the sale or the offer of sale of gasoline that contains benzene 

at a concentration that exceeds 1.5% by volume. Benzene release levels have been 

significantly reduced from a pre-regulation average of 1.6% by volume to a current 

average of 0.7% by volume (over a 50% reduction), while ambient benzene levels have 

fallen by 45% in 2001. 

Other regulations regarding benzene releases include the On-Road Vehicle and Engine 

Emission Regulations and the Off-Road Small Spark-Ignition Engine Emission 

Regulations. The Gasoline and Gasoline Blend Dispensing Flow-Rate Regulations, which 

came into effect in 2001, also prohibit the dispensing of fuel beyond a maximum flow rate 

of 38 L/min. 

In addition to federal benzene regulations, best management practices were created, 

including the Control of Benzene Emissions from Natural Gas Dehydrators. The oil and 

gas industry has also committed to reductions from natural gas dehydrators, the second 

largest source of benzene releases to the Canadian environment. Environmental codes of 

practice have also been developed for both integrated and non-integrated steel mills to 

reduce benzene releases. Finally, the Canada-wide Standard for Benzene (Phases One 

and Two) called for a 30% reduction in air emissions by the year 2000. 

3. Cadmium 

Health effects

Anthropogenic sources of cadmium include metal production (base metal smelting and 

refining), fuel combustion (power generation and heating), transportation, solid waste 

disposal and sewage sludge application. Except for tobacco smoke, food is likely the most 

significant source of human exposure in Canada. The International Agency for Research 

on Cancer classifies cadmium as a known carcinogen. In experimental animals, inhaled 

cadmium caused lung cancers, while ingested cadmium caused leukemia, testicular 

tumours and proliferative prostatic lesions. Delayed onset and progression of kidney 

damage reflect the accumulation and persistence of cadmium in tissues. The few 

epidemiological studies of cadmium and cognitive function in children have yielded 

inconclusive findings because of inadequate exposure assessment and lack of control for 

potential confounders. Prenatal exposure of rodents to relatively low cadmium levels 

caused adverse neurobehavioural effects (Wigle, 2003: 121–122). 

Trends in emissions

Cadmium is a substance that is present in the Canadian environment from both natural 

processes and human activities, including base metal smelting and refining, stationary 

fuel combustion (power generation and heating), transportation, solid waste disposal and 

sewage sludge application. In 1994, cadmium releases were 82 tonnes, while in 2002, 

releases were down to 40 tonnes. The number of reporting facilities increased steadily, 

from 20 reporting facilities in 1994 to 46 in 2001, with a drastic jump to 281 in 2002 

caused by a reduction in reporting thresholds from 10 tonnes to 5 kg with a 0.1% 
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concentration criterion. 

Legislative and policy framework

Inorganic cadmium compounds are listed as toxic under CEPA 1999. Some tools 

developed in reducing cadmium emissions include: 

• New Source Emission Guidelines for Thermal Electricity Generation 

• Environmental Code of Practice for Integrated Steel Mills 

• Environmental Code of Practice for Non-Integrated Steel Mills 

• Contaminated Fuel Regulations 

• UNECE’s Aarhus Protocol on Heavy Metals (ratified by Canada in 1998) 

4. Chromium 

Health effects

The toxicity of chromium depends on its valence state. The three most common forms are 

metallic, trivalent and hexavalent chromium. Nutritional chromium is the trivalent form. 

Hexavalent chromium, the species used in industry, is extremely toxic. Chromium can be 

ingested, inhaled and absorbed through the skin. Hexavalent chromium crosses the 

placenta and passes into breast milk (Etzel, 2003: 185). Hexavalent chromium is a human 

carcinogen, and chronic inhalation of chromium is associated with an increased risk of 

lung cancers among adults. Hexavalent chromium has a number of other toxicities. Low 

birth weight, birth defects and other reproductive toxicities have been observed in 

experimental models of chronic hexavalent chromium exposure. Type IV hypersensitivity 

skin reactions with contact dermatitis or frank eczema are common consequences of 

long-term dermal exposure (Etzel, 2003: 286). 

Trends in emissions

Chromium is a naturally occurring metal that exists mostly in the trivalent or hexavalent 

form throughout Canada. On-site chromium releases remained at a steady level between 

the years 1994 and 1996 (65 tonnes and 69 tonnes, respectively) and then exhibited a 

drastic increase beginning in 1997 and ending in 1999 (790 tonnes and 1048 tonnes, 

respectively). Emissions of chromium hit a peak of 1740 tonnes in 1998, only to drop 

again to 161 tonnes in 2000. The peak in 1998 was caused by a single nickel, copper and 

ore mining facility with a one-time release of 1545 tonnes (approximately 89% of total onsite releases) to land. During this period, the number of reporting facilities increased 

steadily, beginning with 199 facilities in 1994 and ending with 449 facilities in 2002, 

representing over a twofold increase. In 2002, reporting thresholds for chromium releases 

were lowered, such that the reporting of hexavalent chromium was no longer included, as 

a result capturing more facilities. 

Legislative and policy framework

Hexavalent chromium compounds are listed as toxic under CEPA 1999. Sources of 

chromium are primarily from industrial applications, including the production of stainless 

and heat-resistant steels, brick and mortars, pigments, metal finishing, leather tanning and 

wood preservatives. The combustion of fossil fuels and the smelting and refining of nonferrous base metals also contribute to chromium releases. Human exposure to chromium 

in Canada is most likely from contaminated food sources. 

Guidelines and codes of practice regarding chromium include the New Source Emission 

Guidelines for Thermal Electricity Generation and Recommendations for the Design and 

Operation of Wood Preservation Facilities. 

5. Dioxins and furans

Health effects

Dioxins and furans are toxic chlorinated chemicals that are found in very small amounts in 

the environment, including the air, water and soil. They are also present in some foods. 
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There are 210 different dioxins and furans. All dioxins have the same basic chemical 

“skeleton,” and they all have chlorine atoms as part of their makeup. This is also the case 

with furans. These substances vary widely in toxicity. The one considered most toxic is 

referred to as 2,3,7,8-tetrachlorodibenzo-p-dioxin, or simply TCDD. Scientists have 

researched the effects of dioxins and furans on laboratory animals. While the impact 

varies from one type of animal to the next, the serious health effects that can occur 

include weight loss, skin disorders, liver problems, immune effects, impaired reproduction, 

birth defects and cancer. In people exposed to high levels of dioxins and furans through 

job-related activities or through chemical spills, the health effect seen most often is a skin 

condition called chloracne. There are also some reports of other effects on the skin, liver 

and thyroid and on reproduction and the immune system. There are also reports of an 

increase in cancer. While the evidence of these effects in humans is not conclusive, the 

findings generally support the results of animal studies. Scientists agree that exposure to 

dioxins and furans should be kept as low as possible (Health Canada, 2004c). 

Trends in emissions

Dioxins and furans were added to the NPRI substance list in 2000. Between 2000 and 

2002, releases decreased from 100.5 g TEQ to 92.5 g TEQ, while the number of reporting 

facilities increased from 300 to 345, respectively. Many factors contribute to the decrease 

in dioxins and furans, including improved accuracy in reporting through testing, facility 

closures or improvements to the facility. Metal producers do not have a quantitative 

threshold for reporting—all facilities that use or engage in activities that have the potential 

to incidentally manufacture dioxins and furans must submit an NPRI report. In 2002, the 

sectors emitting the greatest quantity of dioxins and furans were primary metal 

manufacturing, electricity generation and waste management. 

Legislative and policy framework

Dioxins and furans are released as by-products of combustion and many industrial 

processes. They also occur as micro-contaminants in the manufacture of chlorinated 

organic chemicals, in the production of cement and in metal smelting operations. Once 

emitted, they can travel long distances from the source, with a long life span. 

Over the last decade, atmospheric releases have been reduced by approximately 60% 

due to facility closures or process technology changes. For example, the upgrade of the 

Quebec Levis Municipal Waste Incinerator resulted in bringing the largest single source of 

dioxins and furans to below the level of quantification, achieving virtual elimination from 

the source. Similarly, the pulp and paper industry was a major source of releases in 

effluent waste. After the implementation of dioxin and furan effluent regulations in the 

1990s, this sector achieved virtual elimination of its effluent, with a reduction of over 99%. 

Under the Toxic Substances Management Policy (CEPA 1999), polychlorinated dibenzop-dioxins (PCDDs or dioxins) and polychlorinated dibenzofurans (PCDFs or furans) are 

slated for virtual elimination, as they were determined to be toxic under CEPA 1999 and 

are persistent and bioaccumulative. Dioxins and furans are also listed on the UNECE 

POPs Protocol as toxic, with the potential for long-range transport through the 

atmosphere. 

In addition to the CEPA 1999 and UNECE regulations, the federal government has 

imposed several regulations and Canada-wide Standards regarding the release of dioxins 

and furans: 

• Pulp and Paper Mill Effluent Chlorinated Dioxins and Furans Regulations 

• Canada-wide Standard for Incineration 

• Canada-wide Standard for Iron Sintering 

• Canada-wide Standard for Coastal Pulp and Paper Boilers 

• Canada-wide Standard for Steel Manufacturing Electric Arc Furnaces 

• Canada-wide Standard for Conical Waste Combustion for Municipal Waste 

6. Hexachlorobenzene
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Health effects

HCB is a persistent substance that has been distributed to all regions of Canada, primarily 

through long-range transport and deposition. As a result, HCB has frequently been 

detected in the various media to which humans and other organisms in Canada may be 

exposed, particularly in sediments and fatty tissues, where it tends to accumulate. Several 

studies in experimental animals have demonstrated reproductive toxicity following 

exposure to low doses of HCB. Similarly, HCB affects the immune system. HCB is 

classified in Group II (probably carcinogenic to humans) and is considered a nonthreshold toxicant (i.e., a substance for which there is some probability of harm for the 

critical effect at any level of exposure). Virtually all (>98%) of the estimated intake of HCB 

by members of the general population of Canada is via food, primarily through dairy 

products such as milk, butter and ice cream and to a lesser extent through fresh meat and 

eggs and peanuts/peanut butter. HCB accumulates in breast milk, and the estimated 

intake for breast-fed infants is greater than in other age groups of the general population 

(Government of Canada, 1993c).

Trends in emissions

HCB was added to the NPRI substance list in 2000. Between 2000 and 2002, total 

releases of HCB increased from 0.037 to 0.045 tonnes and the number of reporting 

facilities increased from 299 to 336, representing a 20% increase in total on-site releases 

and a 14% increase in number of reporting facilities. The reporting of HCB releases does 

not have a quantitative threshold, but is based on specific activities. Any facility that uses 

or engages in specified fuel combustion, metal smelting, production and waste 

incineration-based activities that have the potential to incidentally manufacture HCB must 

submit an NPRI report. In 2002, the sectors that reported the largest HCB releases were 

electric power generation, metal manufacturing, and mining and smelting. Typically, HCB 

is a by-product of chemical manufacturing, wood preservation plants and waste 

combustion. 

Legislative and policy framework

Under CEPA 1999, HCB is considered to be a toxic, persistent and bioaccumulative 

substance slated for virtual elimination under the Toxic Substances Management Policy. 

In addition, it is considered on the UNECE Persistent Organic Pollutants (POPs) Protocol 

as a toxic substance with the potential for long-range transport through the atmosphere. 

Some regulatory and non-regulatory tools used to manage this substance determined to 

be toxic under CEPA 1999 include the following: 

• Prohibition of Certain Toxic Substances Regulations, 2005 

• Interprovincial Movement of Hazardous Waste Regulations

• Recommendations for the Design and Operation of Wood Preservation Facilities 

• Level of Quantification (LoQ) for HCB in Releases to Soil 

• Level of Quantification (LoQ) for HCB in Air Emissions 

• CEC’s Draft Phase One North American Regional Action Plan on Dioxins and 

Furans, and Hexachlorobenzene 

7. Mercury 

Health effects

Mercury exists in three forms: in its elemental form, as inorganic salts and as organic 

mercury. Mercury compounds can be toxic at very low levels in the environment. 

Scientists cannot tell us what level of mercury in our environment would be considered 

“safe.” Converted by bacterial action in lakes and waterways to the more toxic form known 

as methylmercury, the substance then bioaccumulates in fish and shellfish. The toxic form 

gets concentrated as it is transferred up the food chain to birds, animals, marine 

mammals and humans in a process known as biomagnification. High levels of exposure 

can cause severe health problems immediately, but it is the lifetime accumulation of 

mercury that is the greater risk to future mothers and their babies. Mercury is a 
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neurotoxin—it can cause damage to the brain and central nervous system. It also affects 

the kidneys and lungs. Methylmercury is known to affect learning ability and development 

in children (Environment Canada, 1999c). 

Trends in emissions

Total on-site releases of mercury varied between 3.8 tonnes in 1994 and 2.0 tonnes in 

1999, showing no apparent tendency. In 2000, mercury releases increased dramatically to 

6.2 tonnes, decreasing slightly to 5.8 tonnes in 2002. This overall increase is due to a 

reduction in reporting threshold to 5 kg with no concentration limit. As a result of the 

change in reporting threshold, the number of reporting facilities increased from 5 in 1994 

to 308 in 2002. In 2002, 5.4 tonnes (93% of total on-site releases) were air releases. The 

sectors that emitted the greatest quantity of mercury were electrical power generation and 

base metal smelting. Mercury may become airborne when coal is burned or when 

mercury-containing fuels are combusted. Fossil fuel (coal) combustion is a primary source 

of mercury. 

Legislative and policy framework

Mercury has been determined to be toxic under CEPA 1999 and has been added to 

Schedule 1, the List of Toxic Substances. Mercury has been an NPRI substance since its 

inception. In addition to CEPA 1999, the federal government also participates in a number 

of international activities to reduce mercury releases, such as: 

• UNECE’s Aarhus Protocol on Heavy Metals 

• CEC’s North American Regional Action Plan on Mercury

• The Great Lakes Binational Toxics Strategy 

• The Arctic Council Action Plan Mercury Project 

• The New England Governors/Eastern Canadian Premiers Mercury Action Plan 

Federal and provincial mercury initiatives are also being initiated, including: 

• Chlor-Alkali Mercury Release Regulations 

• Canada–Ontario Agreement Respecting the Great Lakes Basin Ecosystem 

• Harmful Pollutants Annex to the Canada–Ontario Agreement Respecting the 

Great Lakes Basin Ecosystem 

Canada-wide Standards for mercury-reducing initiatives include: 

• Mercury in Dental Amalgams 

• Mercury-containing Lamps 

• Base Metal Smelting and Waste Incineration 

8. Lead

Health effects

Lead occurs naturally in the environment and has many industrial uses. However, even 

small amounts of lead can be hazardous to human health. 

Everyone is exposed to trace amounts of lead through air, soil, household dust, food, 

drinking water and various consumer products. The amount of lead in the environment 

increased during the industrial revolution and again significantly in the 1920s with the 

introduction of leaded gasoline. However, since the early 1970s, lead exposure in Canada 

has decreased substantially, mainly because leaded gasoline and lead-based paint were 

phased out and the use of lead solder in food cans was virtually eliminated. Short-term 

exposure to high levels of lead can cause vomiting, diarrhea, convulsions, coma or even 

death. Severe cases of lead poisoning are rare in Canada. However, even small amounts 

of lead can be harmful, especially to infants, young children and pregnant women. 

Symptoms of long-term exposure to lower lead levels may be less noticeable but are still 

serious. Anemia is common, and damage to the nervous system may cause impaired 

mental function. Other symptoms are appetite loss, abdominal pain, constipation, fatigue, 
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sleeplessness, irritability and headache. Continued excessive exposure, as in an 

industrial setting, can affect the kidneys. Lead exposure is most serious for young 

children, because they absorb lead more easily than adults and are more susceptible to 

its harmful effects. Even low-level exposure may harm the intellectual development, 

behaviour, size and hearing of infants. During pregnancy, especially in the last trimester, 

lead can cross the placenta and affect the unborn child. Female workers exposed to high 

levels of lead have more miscarriages and stillbirths (Health Canada, 2004d). 

Trends in emissions

Overall, while the number of reporting facilities increased by 10% between 1995 and 

2000, total releases of lead and its compounds decreased by 46%. Releases increased 

moderately from 1995 to 1997, followed by a decrease in total releases from 1998 to 

2000. Off-site releases (primarily transfers to landfills) accounted for the largest portion of 

releases and variation over this time period. On-site land releases decreased by 70% 

from 1995 to 2000. On-site releases to the air decreased from 1996 to 1999 but showed 

an increase (of 0.6%) from 1999 to 2000. With the introduction of unleaded gasoline in 

Canada in 1975, lead concentrations in the air have declined significantly. Leaded 

gasoline in cars was banned in Canada in 1990. Total estimated lead emissions to air 

(including those reported to the NPRI) decreased by 67% between 1994 and 2002. 

Legislative and policy framework

Lead was one of the first substances named to CEPA 1999’s List of Toxic Substances. As 

a result, the federal government is allowed to control the importation, manufacture, 

distribution and use of lead and lead compounds in Canada. Regulations under CEPA 

1999 also restrict the use of lead in gasoline and control its release from secondary lead 

smelters. Disposal of materials containing certain concentrations of lead at sea is also 

regulated by CEPA 1999. 

In addition to CEPA 1999, the federal Fisheries Act prohibits the release of any substance 

that is harmful to fish or their habitat. Releases from metal mines and processing facilities 

are also regulated under the Metal Mining Liquid Effluent Regulations and Metal Finishing 

Liquid Effluent Guidelines under the Fisheries Act. Compounds containing lead are 

controlled by the Hazardous Products Act, the Food and Drugs Act and the Pest Control 

Products Act, while the shipping and transport of substances containing lead are 

regulated under the federal Transportation of Dangerous Goods Act. 

In combination with federal regulations are a number of risk management tools that aim to 

reduce levels of lead emissions, which include: 

• Secondary Lead Smelter Release Regulations 

• Regulations Amending the Gasoline Regulations 

• Gasoline Regulations 

• Fuels Information Regulations

• Gasoline and Gasoline Blend Dispensing Flow Rate Regulations 

Strengths of the 

indicator 

• The indicator provides direct information on releases from major industrial, 

commercial and public facilities in Canada and, if properly constructed, can reflect 

pollution prevention efforts. 

• This indicator highlights the NPRI program to the public. Public access to NPRI data 

can put pressure on industry to adopt best management practices and reduce 

pollutant releases and on governments to evaluate substances of concern and 

implement policy, legislation and risk management measures. 

• This indicator, in combination with other indicators of exposure or health effects, can 

be used as a starting point for evaluating whether pollution prevention measures 

have been effective. 

Limitations of the 

indicator 

• NPRI data do not encompass all substances emitted to the environment. 

• Reported NPRI emissions generally underestimate the actual chemical load to the 
101 

Indicators 6 and 7 - PRTR data on industrial releases of lead / PRTR data on industrial 

releases of 153 chemicals

Type of indicator: 

Action 

environment. NPRI requires only those industrial, commercial and public facilities that 

meet the reporting requirement to submit their release estimates. This does not 

include other sources from which substances are emitted to the environment—for 

example, non-point source emitters (i.e., cars) or facilities that emit below the 

thresholds. Certain industry/activity sectors are exempted from reporting emissions to 

the NPRI, such as agricultural operations, mining (extraction) and oil and gas 

exploration. In aggregate, these sources could emit large quantities to the 

environment. 

• NPRI data do not supply a direct measure of the ultimate environmental fate and 

behaviour of chemical substances. Thus, they are not an estimate of risk to humans 

or ecological populations. Additional data on exposure levels and pathways and the 

toxicological or hazardous nature of the chemicals are needed to begin to assess the 

potential impacts on human health and the environment. 

Additional indicators Additional indicators that could be appropriate to use in this area are actual levels of these 

chemicals in ambient air, water, soil and food, which would give a better indication of the 

fate of those chemicals in the environment and the sources of human exposure. They 

would also indicate whether the chemical load to the environment is increasing or 

decreasing over time. Many of the substances of concern to children’s health are nonthreshold toxicants—substances for which there are no “safe” levels of exposure (e.g., 

lead). 

For many substances, scientific evidence shows that adverse health effects are 

associated with very low levels of exposure (especially in utero). While reporting 

thresholds should be lowered to reflect the risk associated with low levels of exposure, 

monitoring of levels of those substances in ambient air, water and soil would be most 

appropriate to detect those low levels. 

The best indicator of human exposure to specific chemicals would be biomonitoring data. 

Opportunities for 

improvement 

• Since only facilities meeting the reporting requirements are included in the NPRI’s 

work, combining data sources and estimating total anthropogenic releases to the 

environment, such as in the mercury inventory, would provide Canadians with a more 

comprehensive picture of the total releases into environmental media and remove the 

potential for misinterpreting the trends in the NPRI data. 

• There are no targets or benchmarks against which to compare emission levels for 

many of the substances reported. 

• Currently, there are many chemicals not reported to the NPRI that may be affecting 

children’s health. Therefore, the number of chemicals being reported to the NPRI 

could be increased to reflect the risk of exposure of children to these chemicals. 

• Another approach to presenting the data would be to report geographically (i.e., using 

geographic information systems) by representing communities that may be more at 

risk than others, based on the type and amount of substances emitted locally. 

Related 

programs/activities 

Substances in the NPRI that are determined to be toxic under CEPA 1999 are managed 

through specific programs. The Government of Canada’s Toxic Substances Management 

Policy puts forwards a precautionary and preventive approach to deal with substances 

that enter the environment and could harm the environment and/or human health. It 

provides a framework for making science-based decisions on the effective management 

of toxic substances. CEPA 1999 provides the federal government with new tools to 

protect the environment and human health, establishes strict timelines for managing toxic 

substances and requires the virtual elimination of releases to the environment from toxic 

substances that are bioaccumulative, are persistent and result primarily from human 

activity. 

The Toxics Management Process is the consultative approach taken to develop 

management tools for toxic substances under CEPA 1999. Under this process, 

Environment Canada and Health Canada prepare a risk management strategy, which 

outlines the proposed approach for reducing risks to human health or the environment 

posed by a substance found toxic under CEPA 1999. 

Environment Canada’s Management of Toxic Substances website: 
102 

Indicators 6 and 7 - PRTR data on industrial releases of lead / PRTR data on industrial 

releases of 153 chemicals

Type of indicator: 

Action 

http://www.ec.gc.ca/Toxics/ 
103 

Indicator 8 – Pesticides Type of indicator:

Exposure surrogate

INDICATOR description

Definition Percentage of fresh fruits and vegetables with detectable organophosphate (OP) 

pesticide residues reported by the Canadian Food Inspection Agency (CFIA) 

program from 1995 to 2002 

Rationale and role Children's consumption of fruits and vegetables is relatively high. This can be a 

major dietary source of exposure to pesticides. 

Data sources, 

availability and quality 

CFIA residue monitoring database, 1995–2003. Data from the CFIA are optimized 

for enforcement of maximum residue levels for Canadian food. Number of 

detections is established according to detection limits by standardized multiresidue 

methods, subject to strict quality control. 

Units of measurement Percent fraction 

Computation Yearly enumeration of residues above 0.017 ppm for all OP pesticides on fruits and 

vegetables, expressed as a percentage of sample size 

Sources of further 

information 

None 

Geographic scale National 

Useful references CFIA Chemical Residue Annual Reports 1995–2002 

INDICATOR presentation and observations 

Key observations Percentage of fresh fruits and vegetables with OP pesticide residues has decreased 

over the years, suggesting reduced exposure from this source. 

Strengths of the 

indicator 

The indicator is a weak estimator of overall children exposure because it captures 

only part of the overall diet and does not capture other sources of exposure. 

Limitations of the 

indicator 

The indicator cannot estimate children’s risk or health outcome. 

Additional indicators Biomonitoring of pesticides and their metabolites in urine 

Opportunities for 

improvement 

Implement a reporting system for adverse effects, expected to be available by 2007. 

Related 

programs/activities 

None 

Table 1: Percentage of fresh fruit and vegetables (combined domestic and imported fruits and 

vegetables) with detectable OP residues 

Year Sample size % detected 

1995 10 446 12.3 

1996 9 235 11.9 

1997 8 289 6.1 

1998 6 803 3.9 

1999 8 085 5.0 

2000 8 582 3.6 

2001 14 124 3.7 

2002 15 530 3.0 
104 

Indicator 9 - Percentage of children (households) without access to treated 

water

Type of indicator: 

Action

INDICATOR description 

Definition Percentage of urban Canadians not connected to public water distribution systems 

in their homes 

Rationale and role Access to clean disinfected water greatly reduces the risk of exposure to 

waterborne pathogens for children. Water treatment also helps to reduce the levels 

of some contaminants found in water. It is assumed that Canadians on public 

distribution systems have a very low risk of being exposed to waterborne diseases 

unless there is a failure in technology or management of the water distribution 

system, which, despite best efforts, occasionally occurs. Nationally, it is not known 

how many people have wells that are subject to contamination or how many treat or 

disinfect their water before consumption. 

Data range 1991, 1994, 1996 and 1999 

Terms and concepts Municipal population: Estimate of the population for each municipality. Self-reported 

by municipalities for those who responded to the survey, and taken from the most 

recent Statistics Canada data for non-respondent municipalities. The population cutoff is 1000. 

Municipal population served water: Population in the municipality served by any 

central water distribution system. Does not include population external to the 

municipality. Does not include population on private individual groundwater supplies 

(wells). 

Data sources, 

availability and quality 

The Municipal Water Use Database (MUD) survey collects water use information 

from municipalities in Canada that have a population of over 1000. The survey 

years that are currently available are 1983, 1986, 1989, 1991, 1994, 1996 and 

1999. 

The MUD survey is a self-reporting survey. Thus, the quality of the data for this 

indicator depends on the accuracy and timing of the respondents, the response rate 

of municipalities and the number of municipalities surveyed. The municipal 

response rates were 86% for 1991 and 1994 and 87% for 1996 and 1999. 

MUD data are available at: http://www.ec.gc.ca/water/en/manage/use/e_data.htm 

or from the Environmental Economics Branch, Policy and Communications, 

Environment Canada, 24th Floor, 10 Wellington St., Ottawa, Ontario K1A 0H3 

Census of Canada: Canadian Population (1991, 1996 and 2001). Data available at: 

http://www12.statcan.ca/english/census01/home/index.cfm 

Units of measurement Percentage of Canadians 

Computation For each survey year, the total population served by a central water distribution 

system (i.e., calculated as the total “population served water” reported for all the 

municipalities in MUD) was subtracted from the total Canadian population. This 

number was divided by the total Canadian population to obtain the percentage. 

A procedure was used to estimate “population served water” for non-respondent 

municipalities based on the known “municipal population” (from Census data) and 

the relatively constant ratio between the two (see Environmental Signals, below, for 

details).

Sources of further 

information 

Environment Canada’s MUD survey background information: 

http://www.ec.gc.ca/water/en/manage/e_manag.htm 

Geographic scale National. Data are collected at the municipal level. 

Useful references Environment Canada’s Environmental Signals, Canada’s National Environmental 

Indicator Series 2003, municipal water use indicators for Canada: 

http://www.ec.gc.ca/soer-ree/English/Indicator_series/ 

Environment Canada, Municipal Water Pricing, 1991–1999: 

http://www.ec.gc.ca/water/en/info/pubs/sss/e_price99.htm
105 

Indicator 9 - Percentage of children (households) without access to treated 

water

Type of indicator: 

Action

Health Canada, Water Quality and Health: 

http://www.hc-sc.gc.ca/ewh-semt/water-eau/index_e.html

Canadian Council of Ministers of the Environment: 

http://www.ccme.ca/ourwork/water.html 

INDICATOR presentation and observations 

Key observations • The percentage of Canadians with access, in their home, to water obtained 

from a private individual source has remained constant at about 22–23% 

between 1991 and 1999. This represented about 6.8 million Canadians in 

1999. 

• Canadians not connected to public water distribution systems live mostly in 

rural areas. Nationally, it is not known how many people have wells that are 

subject to contamination or how many treat or disinfect their water before 

consumption.

Strengths of the 

indicator 

National in scope and easy to understand. 

Limitations of the 

indicator 

At the present time, the data collected do not allow us to assess how many 

Canadians on public distribution systems were potentially exposed to pathogens 

during periods when disinfection processes were malfunctioning (i.e., during boil 

water advisories). Furthermore, the MUD survey does not provide compliance or 

performance reports for all treatment plants in Canada. 

Current data collection, at the national level, also does not provide information on 

pathogen occurrence or chemical contamination in private wells. 

This indicator is not expected to change very much, unless major infrastructure 

upgrades are put in place in many parts of Canada or the MUD survey becomes 

more inclusive. The indicator will not reflect changes to current water treatment 

practices (e.g., stricter standards for water quality and reporting problems) or efforts 

to protect drinking water sources (e.g., watershed management). 

Additional indicators See other indicators under theme “Waterborne diseases” of this report.

Opportunities for 

improvement 

Future improvements would include deriving the population of children served by 

various levels of water treatment. 

The MUD survey has been improved for the next cycle of data (2001) and will likely 

provide more reliable and comparable data on boil water advisories and other 

treatment problems. However, detailed data collection on treatment plant 

performance and compliance according to standards or legislation is done at the 

provincial level and in a way that may not be available or consistent across the 

country. Efforts to streamline and centralize this type of information could be 

undertaken, especially in the context of a related program (e.g., Canadian Council 

of Ministers of the Environment Source to Tap Water Protection Strategy). 

A national survey of private well water quality would provide a more complete 

picture of the number of Canadians potentially at risk from waterborne diseases and 

other contaminants. 

Related 

programs/activities 

There are a number of programs and funds in Canada to support new development 

projects or improve existing infrastructure in Canadian communities, rural areas and 

First Nations communities, including water infrastructure (see 

http://www.infrastructure.gc.ca/index_e.shtml). 

The Government of Canada has allocated new funding over 5 years to ensure the 

safety of water supplies in First Nations communities. This will help to close the gap 

in life chances between Aboriginal and non-Aboriginal Canadians and build healthy 

communities (see information on the First Nation Water Management Strategy at: 

http://www.ainc-inac.gc.ca/H2O/bkg_e.html). 
106 

Indicator 11 - Percentage of children (households) that are not served with 

sanitary sewers

Type of indicator: 

Action

INDICATOR description 

Definition Percentage of urban Canadians that have access to secondary-level sewage 

treatment or better, through a centralized collection system 

Rationale and role Sanitary sewage, when not disinfected, can be a major source of pathogens for 

children engaged in aquatic recreational activities or drinking untreated water in the 

area of influence of an outfall. A number of toxic substances can also be released 

with municipal sewage, posing an additional threat to children’s health. 

Data range 1991, 1994, 1996, 1999 

Terms and concepts Municipal population serviced by sewers: Population in the municipality serviced by 

any sewer collection system. Does not include population external to the 

municipality. In Northern Canada, this includes pump-outs. 

Primary treatment: All population served by collection systems having any form of 

mechanical sewage treatment (in some cases can include screens and meshes). 

Waste stabilization ponds: All population in the municipality served only by waste 

stabilization ponds (also called “lagoons” or “ponds”). Considered to be equivalent 

to secondary level of treatment for this indicator. 

Secondary treatment: All population in the municipality served by biological sewage 

treatment. If municipalities have both “primary” and “tertiary” sewage treatment, they 

are usually combined and counted as secondary. Municipal septic tanks are 

assumed to be operating correctly and providing a secondary level of service. 

Tertiary treatment: All population in the municipality served only by some form of 

sewage treatment providing a higher level of treatment than secondary. Usually 

includes effluent polishing, phosphate removal and sometimes spray irrigation. 

Data sources, 

availability and quality 

The Municipal Water Use Database (MUD) survey collects wastewater information 

from municipalities in Canada that have a population of over 1000. The survey 

years that are currently available are 1983, 1986, 1989, 1991, 1994, 1996 and 

1999. 

The MUD survey is a self-reporting survey. Thus, the quality of the data for this 

indicator depends on the accuracy of the respondents, the MUD definitions provided 

with the survey, the response rate of municipalities and the number of municipalities 

surveyed. The municipal response rates were 86% for 1991 and 1994 and 87% for 

1996 and 1999. 

MUD data are available at: http://www.ec.gc.ca/water/en/manage/use/e_data.htm 

or from the Environmental Economics Branch, Policy and Communications, 

Environment Canada, 24th Floor, 10 Wellington St., Ottawa, Ontario K1A 0H3 

Units of measurement Percentage of Canadians 

Computation This indicator was calculated by a simple summation of the municipal population 

serviced by sewers having primary, secondary or tertiary treatment or waste 

stabilization ponds across Canada, divided by the total population serviced by 

sewers. 

Sources of further 

information 

Environment Canada’s MUD survey background information: 

http://www.ec.gc.ca/water/en/manage/e_manag.htm 

Geographic scale National. Data are collected at the municipal level. 

Useful references Environment Canada’s Environmental Signals, Canada’s National Environmental 

Indicator Series 2003, municipal water use indicators for Canada: 

http://www.ec.gc.ca/soer-ree/English/Indicator_series/

Environment Canada’s The State of Municipal Wastewater Effluents in Canada: 

http://www.ec.gc.ca/soer-ree/english/SOER/MWWE.cfm

Health Canada’s Water Quality: 
107 

Indicator 11 - Percentage of children (households) that are not served with 

sanitary sewers

Type of indicator: 

Action

http://www.hc-sc.gc.ca/ewh-semt/water-eau/index_e.html

INDICATOR presentation and observations 

Key observations In 1999, 22.7 million Canadians (or 74% of the total population), living mostly in 

urban areas, were serviced by municipal sewer systems. This level has remained 

relatively constant throughout the 1990s. The remaining Canadians not serviced by 

sewage collection systems, about 7.8 million people, were generally served by 

private septic tanks, which are routinely pumped out and trucked to communal 

treatment facilities. When not properly installed and maintained, septic systems 

have the potential to contaminate nearby water bodies and groundwater sources. 

The percentage of urban Canadians served by secondary sewage treatment or 

better increased from 48% to 58% between 1991 and 1999. This increase largely 

reflects infrastructure upgrades. A higher proportion of Canadians living in coastal 

areas were served by lower levels of treatment (primary or none). 

About 70% of Canadians served by sewage collection systems in 1999 had effluent 

disinfection. 

Strengths of the 

indicator 

Covers a large portion (83%) of the total Canadian population as part of an ongoing 

survey and is relatively simple to calculate and update. 

Limitations of the 

indicator 

This indicator provides an indirect measure of sewage treatment plant performance 

for removing pathogens and other contaminants. The level of treatment does not 

provide a direct measure of plant removal efficiency. Furthermore, it does not reflect 

sewage bypasses (i.e., when effluents are diverted directly to receiving waters, 

without treatment) when influents exceed plant capacity or during periods of 

malfunction or servicing. 

The indicator is based on Canadians serviced with secondary or better treatment, 

because the original definition of primary treatment was, in some cases, interpreted 

differently by the respondents. In many municipalities, primary treatment does 

provide disinfection of effluent. 

Additional indicators See other indicators under theme “Waterborne diseases” of this report. 

Opportunities for 

improvement 

An improvement to this indicator would be to derive the population of children 

serviced by centralized sewage treatment. 

Collecting detailed data from provincial sewage treatment plant performance and 

compliance would also be an improvement. 

Related 

programs/activities 

There are a number of programs and funds in Canada to support new development 

projects or improve existing infrastructure in Canadian communities, rural areas and 

First Nations communities, including wastewater infrastructure (see 

http://www.infrastructure.gc.ca/index_e.shtml). 
108 

Indicator 12 - Morbidity: number of cases of childhood illnesses attributed to 

waterborne diseases 

Type of indicator: 

Health outcome 

INDICATOR description 

Definition Notifiable Diseases Registry: Number of cases of infection, by age, reported to 

provincial/territorial authorities and collected by Health Canada. 

Cause of infection is not identified. 

Rationale and role The risk of microbial disease associated with drinking water is a concern among 

North American water jurisdictions. Numerous past outbreaks, together with recent 

studies suggesting that drinking water may be a substantial contributor to endemic 

(non-outbreak-related) gastroenteritis, demonstrate the vulnerability of many North 

American cities to waterborne diseases. 

Data range Notifiable Diseases Registry 1988 to 2000: 0–1, 1–4, 5–9, 10–14, 15–19 

Terms and concepts Notifiable Diseases Registry: Giardiasis, sometimes called “beaver fever,“ is an 

intestinal parasitic infection characterized by chronic diarrhea and other symptoms. 

Person-to-person transmission is common where personal hygiene may be poor. 

Community outbreaks may occur by ingesting cysts from fecally contaminated food 

or unfiltered water. Persons with acquired immunodeficiency syndrome (AIDS) may 

have more severe and prolonged illness. 

Data sources, 

availability and quality 

The list of diseases on the national Notifiable Diseases Registry is agreed upon by 

consensus among provincial and federal health authorities through the Advisory 

Committee on Epidemiology. The Advisory Committee on Epidemiology meets 

approximately twice annually, at which times proposed additions and/or deletions to 

the list are debated. Data are available for Campylobacter from 1986 to 1999 and 

for Giardia from 1983 to 1999. These are the years in which these diseases became 

reportable. 

Available online at: 

http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/c_time_e.html 

Units of measurement Notifiable Diseases Registry: Number of cases reported to provincial/territorial 

health authorities per 100 000 population and number of reported cases, both 

available online. 

Computation Notifiable Diseases Registry: Information collected by provincial/territorial health 

departments based on where the patient resides and then passed to Health 

Canada. Health Canada computes both the number of cases and the rate per 

100 000. 

Sources of further 

information 

Notifiable Diseases Registry is available online through the Population and Public 

Health Branch database. 

Geographic scale National. 

Useful references Article by Lim et al. (2002): 

http://www.hc-sc.gc.ca/ewh-semt/pubs/watereau/relation_gastro_edmonton/index_e.html

Government of Canada (1999) Statistical Report on the Health of Canadians

INDICATOR presentation and observations 

Key observations Children aged 1–4 are more likely to be infected with both Giardia and 

Campylobacter. This may be because they are more likely to be brought to a 

primary care provider, less likely to be breastfeeding and more vulnerable to 

infection than older children. 

Strengths of the 

indicator 

Analysis of trend data would provide an indication of increasing or decreasing 

incidence of disease. Further studies would have to be done to link cases with their 

etiology. 

Limitations of the 

indicator 

Cases are not reported to the Notifiable Diseases Registry until the individual seeks 

assistance in the primary care system and the primary care provider reports 
109 

Indicator 12 - Morbidity: number of cases of childhood illnesses attributed to 

waterborne diseases 

Type of indicator: 

Health outcome 

information to the provincial/territorial health unit. Public health scientists 

acknowledge that these illnesses are far more common than the reported numbers 

suggest. Estimates from studies in North America and Europe indicate that as few 

as 1–10% of cases are reported. This may, in part, reflect the mild nature of many 

infections, which are managed at home, or the fact that only a small proportion of 

patients have specimens taken for laboratory tests (Government of Canada, 1999). 

Limitations of the registry include underreporting, timeliness of reporting, disease 

case definitions and passive surveillance. 

Additional indicators Proportion of population with access to adequate sanitary and water treatment 

facilities 

Opportunities for 

improvement 

Within the present system, none 

Related 

programs/activities 

While no program specifically targets children, the Federal–Provincial–Territorial 

Committee on Drinking Water, which represents government departments with 

interests in drinking water quality (usually health and environment) at the federal, 

provincial and territorial levels, has developed a guidance document for managing 

drinking water supplies in Canada. 
110 

Appendix 4 Indicators Steering Group—Canada 

Annie Bérubé 

Office of Vulnerable Populations and Climate 

Change 

Health Canada 

Sir Charles Tupper Building 

2720 Riverside Drive 

Ottawa, Ontario K1A 0K9 

Tel: (613) 941-3610 

Fax: (613) 952-8857 

E-mail: Annie_A_Berube@hc-sc.gc.ca

Vincent Mercier (Country Lead) 

Knowledge Integration Strategies Division 

Environment Canada 

Environmental Science Centre 

Campus, Université de Moncton 

Moncton, New Brunswick E1A 3E9 

Tel.: (506) 851-6244 

Fax : (506) 851-6608 

E-mail: Vincent.Mercier@ec.gc.ca

Susan Ecclestone 

Health Impacts Bureau 

Health Canada 

Sir Charles Tupper Building 

2720 Riverside Drive 

Ottawa, Ontario K1A 0K9 

Tel.: (613) 948-2589 

Fax: (613) 952-8857 

E-mail: Susan_Ecclestone@hc-sc.gc.ca 

Amber McCool 

Strategic Policy Branch 

Environment Canada 

10 Wellington Street 

Gatineau, Quebec K1A 0H3 

Tel.: (819) 997-5087 

Fax: (819) 953-4679 

E-mail: Amber.McCool@ec.gc.ca