HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Tuesday, November 16, 1999

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[English]

The Chair (Mr. Lynn Myers (Waterloo—Wellington, Lib.)): Ladies and gentlemen, we'll call this meeting of the Standing Committee on Health to order. We have a quorum to hear witnesses, and as you know, we're starting off today under Standing Order 108(2) with respect to an information session on Health Canada.

I know we have a lot of ground to cover today and I think it's important that we do so in a very tight fashion and expeditiously in order to leave us all with the time we need to ask questions. Keeping that in mind, I'll ask the associate deputy minister, Madam Marie Fortier, to come forward.

Perhaps you would introduce anyone you think it is appropriate at this point to introduce. Certainly if you have any opening comments to make, we'd appreciate those at this time.

Ms. Marie Fortier (Associate Deputy Minister, Health Canada): Thank you, Mr. Chairman. Bonjour, mesdames et messieurs.

We are very pleased to be here this morning. I'm joined by some colleagues from different branches whom I'll introduce in a second. We're very happy to be here to talk about the organization of the department, but also the three key priorities that the department is pursuing, which are the health of first nations and Inuit people, medicare, and wellness.

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[Translation]

As Associate Deputy Minister, I am here to provide you with a general overview of the Department. Our Deputy Minister is Mr. David Dodge. We have six branches within the department, each of which has primary responsibility over certain areas.

[English]

three of which are represented here today.

With me are Ian Shugart, who is visiting ADM in the health protection branch; Ian Potter, who is the assistant deputy minister of the health promotion and programs branch; and Madame Monique Charron, who is director of program policy and planning in medical services branch, which is the branch responsible for first nations and Inuit health. The three will address you separately, and they are joined by other colleagues.

Tomorrow you will hear from other colleagues. Robert Lafleur, the assistant deputy minister of the corporate services branch, will be with you. Scott Broughton is acting assistant deputy minister of the policy and consultation branch, and Seamus Hogan will speak on behalf of the information analysis and connectivity branch, where he is acting director of health demand and supply analysis.

My remarks will focus of course on the department and its organization and functions. But I would like to emphasize that as a department we work within a much broader environment that is characterized by a partnership with multiple others. That includes of course other federal departments as well as provincial and territorial governments, professional associations, the voluntary sector, and organizations and members of the community, including aboriginal communities.

One aspect of our work is ensuring that citizens are engaged as is appropriate in the conduct of our business in the department. That you might hear about in the presentations over the next day and a half.

The mandate of the department is to help the people of Canada maintain and improve their health.

[Translation]

Working with our provincial and territorial partners, Health Canada provides national leadership in the development of health policy, in the enforcement of health regulations, in the promotion of disease prevention and in the enhancement of healthy living for all Canadians.

Health Canada ensures that health services are available and accessible to First Nations and Inuit communities. It also works closely with various stakeholders to reduce health and safety risks to Canadians.

[English]

The Department of Health Act sets out the duties and powers of the Minister of Health, but in addition to that piece of legislation, there are more than 20 other pieces of legislation administered by the department and the agencies that are attached to the department. Some in fact are shared with other departments, such as the Canadian Environmental Assessment Act. So it's not a simple matter to find in any one piece what we do. It requires a little bit of research to get it all together.

One piece of legislation, of course, that is very well known is the Canada Health Act, which authorizes the cash contributions made to provinces in respect of insured services under the Canada health and social transfer.

The Canada Health Act sets out the basic criteria that provincial and territorial governments must comply with in order to receive their full cash contribution. The five criteria are public administration, comprehensiveness, universality, affordability, and accessibility.

Let me switch now to talking a little bit about the organization and funding of the department.

[Translation]

As shown in the Main Estimates, the total budget for the department is $1.8 billion, or actually, close to $1.9 billion. A portion of these funds is used for grants and contributions for a multitude of research, health promotion and prenatal projects, and so forth. A total of $822 million are allocated to other non- governmental organizations for various activities.

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[English]

In addition to that, the department is connected to the transfer of the CHST to provinces, but that is not part of our budget. That is reflected in the Department of Finance budget. The current value is $12.5 billion, but that is going up, as you know, by a total of $11.5 billion over the next five years.

The total number of employees in the department at the moment is 5,710, roughly. That fluctuates, but that's the closest number available at the moment.

[Translation]

I will now give you a brief overview of Health Canada's six branches, after which you will hear from each ADM or their representatives. We also have four regional offices: one in Atlantic Canada, one in Quebec, one in Central Canada and one in the West.

Furthermore, two agencies report to the Deputy Minister, namely the Pest Management Regulatory Agency,

[English]

the Pest Management Regulatory Agency, as well as the Occupational Health and Safety Agency. In addition to that, there are departmental corporations that report to Parliament through the minister, or for which the minister is accountable to Parliament, but they don't report internally within the department to the deputy.

So a few words about each branch. The policy and consultation branch provides policy advice and support to the minister, the department's executive, and the program branches. A new health care directorate is currently being set up there to support the department's work on medicare and the health care system in general, and you'll hear much more detail tomorrow from Scott Broughton.

Medical services branch is focused on service to clients, and it provides services directly, or funds services, as well as non-insured health benefits for first nations and Inuit people throughout the country. One of the goals of medical services branch is to transfer control over these benefits and programs to first nations and Inuit communities at a pace that is being directed by them.

The health promotion and programs branch plays a national role in improving the physical and mental health and well-being of Canadians. Using a population health approach, it promotes health and disease prevention, and it shares the goal of wellness for Canadians with other branches in the department, including the health protection branch.

Health protection branch's mandate is to protect Canadians against current or emerging health risks in two broad areas: products and diseases. In addition to ensuring the safety of food, drugs, medical devices, and other products, the branch does work in the areas of surveillance, prevention of disease, and the promotion of a healthy living environment.

The information, analysis and connectivity branch, which just celebrates today, actually, its first birthday—and I just came from joining them in that before coming here—is designed to improve the generation and the use of health-related information and research to strengthen the department's analytical foundations, to improve Health Canada's accountability for its programs and activities, and to promote the use of information and communication technologies in the health field. It also provides information management and technology within the department.

Finally, the corporate services branch provides a wide range of corporate services to the rest of us, including those related to finance, human resources, accommodation, and it serves as liaison with central agencies such as Treasury Board and the Department of Finance.

Before concluding, I would like to say a few words about the three key areas that are important to the department.

The first is aboriginal health. As I said a few minutes ago, the medical services branch delivers health services to first nations and Inuit people, but it's also working to transfer control over health services to first nations and Inuit, consistent with the broad objective of the pursuit of self-government. There are enormous challenges to ensuring first nations and Inuit health.

The report that was released last summer, Towards a Healthy Future, the second of such reports on the health of Canadians, did show again the discrepancies between health conditions and health status in aboriginal communities compared to the general performance of Canadians. I think we're experiencing that there's greater awareness of this fact and greater sensitivity to it among Canadians.

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[Translation]

The reasons for poor health among aboriginal populations are complex and solutions will not be found in the short term. The presentation by the Medical Services Branch will provide you with further details about this situation.

[English]

The second theme is medicare. It's clear that the government has taken a major step to support the health care system in the last budget with the infusion of $11.5 billion over the next five years to the Canada health and social transfer. In addition, resources to key initiatives, including health research, will make a significant contribution to better information and better knowledge on which to base decisions. And that includes policy decisions of course, but as well decisions about clinical practice and health service organizations and population health.

Such investments have helped to lighten the pressures on the health care system and to strengthen our support. But advancing and increasingly expensive technology, and other factors such as changing demographics—including aging, but not just that—will continue to create pressures on the system as a whole. So our job isn't finished in this area, of course.

[Translation]

The recent Speech from the Throne clearly reflected once again the government's strong commitment to Canadians' well-being. Our department is continuing to work with the provinces and other partners to modernize the health care system. Our goal is to build an integrated system that offers services efficiently and that upholds the principles and values of the Canada Health Act.

Research, the development of quality standards and innovations in a variety of areas, including homecare and pharmaceuticals, are just a few examples of our ongoing involvement with provincial governments and other partners.

[English]

Finally, wellness: The minister has challenged us to place greater emphasis on wellness, on health, as we continue our very important work on medicare. While we continue to support the health care system, we are working harder on the other side of the equation, that is, how to help Canadians maintain their health in order to lessen their dependence upon the doctors and hospital part of the system, or other aspects of health care such as drugs, etc.

We're developing a framework for current and future health promotion and disease prevention activities to address health behaviours in living and working conditions, including environmental health. Research and information technology are central to this, as they are to many other things, and they'll certainly play an increasingly important role in effective action on wellness.

Consistent with the throne speech and the national children's agenda, the minister also emphasizes special concerns for the wellness of children.

[Translation]

You will be hearing more details about these activities this morning and tomorrow as well.

[English]

But I'm certainly willing and able to answer questions and would be delighted to do so. Obviously I'm delighted to do that in both languages. Thank you.

The Chair: Merci beaucoup, Madame Fortier. I'm cognizant of your time constraints this morning. How long do you have to stay with the committee? I'm just thinking in terms of questions.

Ms. Marie Fortier: As long as you wish. I know you want to hear from these three other colleagues before 1 o'clock, but I'm certainly available for another 20 minutes, or 25 minutes if necessary.

The Chair: Thank you very much.

Mr. Martin, lead off, please, for seven minutes.

Mr. Keith Martin (Esquimalt—Juan de Fuca, Ref.): Thank you, Mr. Myers.

Madame Fortier, thank you very much for attending the committee.

Aboriginal communities around the country, as you said, are suffering from horrendous levels of mortality, morbidity. Money is being put in, and I would submit to you that the accountability is not there. In my riding I have a Pacheenaht reserve, and you're probably very familiar with the suicide problems they have there. We have tried to allow the hereditary chief to have information and access to information that he has a right to, but he's been shut out by the current council. It's happening in reserves across the country. When I asked the Department of Indian Affairs to intervene, they said they couldn't because the council won't allow them.

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What I'm driving at here is that people on the bottom, on aboriginal reserves, who are suffering tremendously, can't get the answers as to where moneys are going within their communities. Money is poured in and they don't see any observable benefit. Children are still lying on the floor, on bare concrete. I don't need to go through the statistics, you know them very well. What is your department doing in order to make sure there's going to be accountability and transparency, and that the people on the ground are getting the resources you're putting out for them? How do you actually assess whether or not you're having any effect? In many of these communities we've had no effect at all, or little effect.

Ms. Marie Fortier: Thank you. The notion of accountability is a very complicated one. I think in many parts of the health care system, in our case and certainly in provincial governments, and I'm sure at the community level, it's a big challenge to link resources to results, in large part because, as you well know, health outcomes are frequently the result of factors other than the health services that are being provided.

By saying that, I don't want to duck the responsibility for the services themselves. It's very important that they be there and that people understand what is available to them. But in general it's clear that—and if you look at the Second Report on the Health of Canadians, you'll see—the link between the service component and improvement in health status is not very direct. In fact it is not even proportional with expenditures. Frequently the factors that do have an impact are well outside the control of health care providers of any type.

That being said, the accountability within first nations communities—because I think that's the area we can focus on, and I believe that's what you had in mind—is obviously between the population and their elected chief and members of the council. It's a very tricky matter for us to intervene in their accountability to each other. We certainly have accountability mechanisms for reporting back to us, and at different levels that varies, depending on the degree of autonomy they've acquired through different kinds of arrangements we've worked out with them. Monique Charron can certainly answer in more detail in terms of what different regimes we have, depending on whether we're in a contribution agreement situation, for instance, versus a full transfer, and in some cases there are even more autonomous self-government agreements that we are part of with Indian and Northern Affairs.

Mr. Keith Martin: All I can suggest to you is that the accountability isn't there and the people on the bottom are the ones who are getting it in the neck. And they're getting it in the neck even though you're pouring a lot of money into the system, and nothing's been changing. In the years I've been practising medicine, I haven't seen a change.

Second, you saw that 74% of Canadians would like to have an opportunity to be able to purchase private health care services if they so chose to. Are you going to examine the role of private services within the context of a Canadian medical system?

Ms. Marie Fortier: I think what we're really concerned about is the growing underlying concern of Canadians about access to services. I've not seen the details of that poll, but from what I read in the papers yesterday, it would appear that Canadians—and it's not new, we're heard this repeatedly; I was involved with the National Forum on Health and we heard that throughout the country at the time—have accepted a bargain with their governments, not just the federal government, and it is that we will contribute through our taxes towards a system that assures everybody equal access based on need. The bargain is that in exchange we'll be assured of access to services when we need them individually, without unreasonable barriers. Certainly financial barriers to access have been ruled out.

But when, in the judgment of individuals, that access becomes too difficult, then people begin to think maybe there's an option. It's relatively easy to imagine that one option might be to just go out and acquire the services privately if they were available. So depending on how those questions are asked, you frequently get this kind of result.

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I think what we have to address are the underlying considerations people have, and that is how to ensure that people continue to have access to the broad range of integrated services they need. In today's health care delivery system, it means a variety of community-based services. It means extended home care, and it means other things. It's going to be a challenge to find ways to make that more broadly available as the availability of resources grows only at a certain rate. While we've injected $11.5 billion over the next five years, that's still over five years, so it takes a while before those resources can be transferred into expanded services by provincial governments.

So we have our challenge cut out for us in working through that over the next year. I think on balance Canadians are still saying to governments that we want equal access without barriers. What we have to resolve is why is it they feel they don't have that now, and how can we improve that over time?

[Translation]

The Chairman: Thank you very much, Ms. Fortier.

Do you have a question, Mr. Ménard?

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ.): Yes. I have a request, along with several brief questions that I will ask all at once. This will make it easier for everyone, and for the witness as well.

Do you have an explanatory or annotated version of the Canada Health Act, the Food and Drug Act and the Tobacco Act that you could possibly make available to members? This would give us a better understanding of the legislation administered by the department.

As for my questions, could you briefly review for us the follow up given to the recommendations made by the Krever Commission? Have steps been taken to implement the report's main recommendations?

Secondly, as you know, the drug licensing process has been the target of harsh criticism, particularly when compared to the process followed in the United States. Could you update us on this situation?

Thirdly, one expression appears to have set the tone of your department's policy directions, namely the "determinants of health". These were the major focus of the 1994 National Forum and of the report subsequently released. How do these determinants affect the different programs and policies implemented by your department?

Lastly, has one of your department's six branches done a follow up and analyzed the impact of the government's cuts to transfers to the provinces for health care? Has this been done? Does your department's new branch—the official launch of which was celebrated earlier, although I wasn't invited to the celebrations, but no matter—namely the Information, Analysis and Connectivity Branch, have any data on the impact of cuts to transfer payments for health care?

Ms. Marie Fortier: Thank you for your questions. In response to you first question concerning the various statutes, to my knowledge, there are no annotated versions of these statutes available. I've never seen any. However, that doesn't mean that someone can't give you an overview of the broad principles of each act.

With respect to health protection, we administer several acts and Ian Shugart can elaborate on this for you later. Unfortunately, I don't have the material you're requesting.

As for a status report on the Krever Commission recommendations, that question is rather far-reaching. It would be impossible for me to respond appropriately in the time allotted to us. We would need a little more time to do that. I'll ask Mr. Shugart if he can speak to this issue for a few minutes. Perhaps we may have to come back to this subject at a later time and provide you with a written response. This commission covered a lot of ground and made many recommendations.

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Mr. Réal Ménard: I'm thinking primarily about the commission's main recommendation, which I'm sure no one has forgotten, yourself included, which called for a compensation package for victims, regardless of who was at fault. If there's one recommendation that can make all the difference in victims' lives, surely it is this one.

Ms. Marie Fortier: Mr. Chairman, if it's alright with you, we could provide a written response to that question sometime after the meeting. Otherwise, we could come back at another time to discuss the recommendations.

[English]

The Chair: Excuse me, Madame Fortier, I think that would be a good idea, and it's something that would circulate to all members. So if you could provide that, that would be excellent.

Ms. Marie Fortier: Okay. With respect to

[Translation]

As for your question concerning the drug licensing process, I'll let Mr. Shugart field that when he makes his presentation.

Mr. Réal Ménard: By all means.

Ms. Marie Fortier: As for your question concerning the determinants of health, this is indeed a timely concept. We talk about wellness or population health. Increasingly sophisticated research is showing that far more factors then we ever believed possible impact people's health.

The Lalonde Report produced by the Department of Health in 1973 is out of date today because we now realize that some factors once viewed as static, for instance, genetic factors, may no longer be static in the future.

The concepts and ideas on which we base our understanding of what will affect people's health in the future are constantly being challenged by scientific, technological and information systems changes.

Therefore, in our view, this is a very relevant concept, one that influences our thought processes, our research and our approaches. As Mr. Potter will tell you, a greater understanding of the determinants of health will help us to develop programs that will get people involved in health care issues at the local level.

Clearly, if these determinants are to be influenced in any way, the cooperation of the various stakeholders is almost always needed and the best place to achieve this cooperation is at the community level. Funding by the department and by provincial governments for health care helps support community action and is motivating factor.

This also leads to action on the health protection front, because a person's physical environment constitutes a determinant of health. This may be one area over which people have the least amount of control. I'm talking about the air we breathe, the water we drink, as so forth.

Regarding your final question, which had to do with the impact of government cuts, the Health Policy Branch, the new branch you talked about, that is the Information, Analysis and Connectivity Branch, and the Canadian Institute for Health Information, which receives funding from the department, continue to compile data on variations in health care spending.

Obviously, we are monitoring spending by the provinces in this area, that is whether spending is down or up. Monitoring the situation is critical because it helps us to anticipate future requirements and to grasp fully the problems with which provincial governments and the public must contend.

Currently, the government is not in a cost-cutting phase. We are experiencing growth, moderate growth admittedly, but growth nevertheless and all governments have announced increased spending for the current year. Further increases in spending can reasonably be anticipated in the future.

In the hospital sector, the reverse has been happening. Spending on medical services has been static. Spending has increased the most in the pharmaceuticals sector. Other kinds of spending fall into a category which is poorly understood, a category that includes home care. More analysis of this sector is needed to enhance our understanding of the situation.

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Mr. Réal Ménard: Do I have time for one last question?

[English]

The Chair: No, it's all over, Mr. Ménard. Thank you very much.

[Translation]

Go ahead and ask your question, Mr. Patry.

Mr. Bernard Patry (Pierrefonds—Dollard, Lib.): Thank you for coming here today, Ms. Fortier.

On another subject, you talked to us today about three priorities: the First Nations and Inuit communities, medicare and wellness.

I'd like to discuss with you prevention programs that target our children, our youth and our seniors. As you mentioned, in the recent Speech from the Throne, the government reported on its National Children's Agenda. I'm delighted with this initiative because in my view, this is the first step toward eliminating child poverty and, indirectly, toward improving the health of our youth.

Over 15 federal departments have responsibility for the health of children. Personally, I feel that there is not only duplication, but maybe even "triplication"—call it what you will. As far as I'm concerned, everyone is responsible for the health of children, including Health Canada which should have even more responsibility over this area. Don't you think that it's high time for child health and prevention programs to be the responsibility of one single department? At present, everyone is involved in prevention programs and I get the feeling that the right hand has no idea what the left hand is doing!

You are responsible for anti-smoking policies and programs. In Quebec, 38 per cent of young people between the ages of 13 and 15 smoke. A carton of cigarettes costs $18 more in Quebec and Ontario than in certain U.S. border states and a $1.25 increase per carton has just gone into effect. As a doctor, I'm very disappointed to see what's going on. We were merely told that it was the RCMP's decision to raise the price of a carton of cigarettes. In my view, increasing cigarette prices should be Health Canada's responsibility, and not something left up to the RCMP. Thank you.

Ms. Marie Fortier: Thank you, Mr. Patry.

There's no question that there are many partners involved in programs related to child health. The challenge has been, and will continue to be, to ensure that the various stakeholders work together to achieve the best possible results.

Fortunately, working in cooperation with other federal departments and through our consultations with the provinces, we have succeeded in developing a rather ambitious agenda, as set out in the Speech from the Throne. We have already taken a giant step in that we have defined the role we must play and the appropriate initiatives to be taken. We have many decisions left to make, not the least of which concerns the resources that we will be requesting in upcoming budgets to follow through on our commitments.

The health of children during the first few years of life is the Minister's top priority. This includes prenatal care. Our federal colleagues generally recognize that interaction with the health system is the best way to identify problems during early childhood and to promote action, not always necessarily medical intervention.

Despite the number of stakeholders involved, we have made significant progress on this front over the past few years. I'm fairly optimistic about the future of this collaborative effort because mechanisms have been initiated. It's almost impossible to separate or to draw clear lines of responsibility. The department's leadership is opting for an approach based on the best collaborative efforts possible, instead of trying to keep certain areas of responsibility all to itself, which could mean that some issues wouldn't come under anyone's purview in particular and could be overlooked.

On the tobacco issue, I'd just like to say that the recently announced price increase was negotiated by the Finance Department and by the provinces involved. Obviously, this was not the kind of increase that everyone would have liked to see in the short term. It may be only a first step in an ongoing process.

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[English]

The Chair: Thank you very much. You have a couple of minutes, Mr. Patry.

Mr. Bernard Patry: I have just one more question

[Translation]

regarding seniors. As everyone well knows, the aging of the population will be one of the biggest challenges we face in the future and one that we will likely have to tackle in the next decade. The aging of the population will be the primary cause of rising health care costs. In fact, the Senate has undertaken a study on aging.

I'm not interested in your predictions, but I would like to know what the department's plans are in terms of prevention programs targeting seniors. In Quebec, we've reached the point where some people are wondering whether people over the age of 80 should be treated at all because of the cost involved. That, in my opinion, is a totally unacceptable argument. What is the department's position on this matter?

Ms. Marie Fortier: I hope I understood the gist of your comment. You say that it's unacceptable to even wonder if care should be provided to the elderly.

Mr. Bernard Patry: Absolutely unacceptable.

Ms. Marie Fortier: This is indeed a very important issue to us because we realize that if we fail to analyse the problem sufficiently, we run the risk of taking too much for granted. Tomorrow's seniors may not necessarily have the same health profile, the same resources or the same expectations as the seniors of yesteryear. Some caution, therefore, is in order.

The Deputy Minister has mandated a senior adviser to examine how this problem will impact our society over the next 20 years. The first step is to analyze more closely the impact that these phenomenons will have. What kind of socioeconomic conditions will seniors enjoy over the next 20 years, what kind of pensions will they have, what services will they need and what kind of discrepancy will there be between the current level of services they enjoy and the services they might require in future?

We are a long way from proposing specific measures, but the first stage of the process is very important nonetheless. The issue needs to be clearly and broadly defined, because health services aren't the only consideration. In future, good health will probably be more a function of a person's socioeconomic status. No one, including Health Canada, can stop the aging process.

However, before formulating health services policies, we need to look at the bigger picture and that's what the department is beginning to do. Other departments are currently examining this issue as well. Clearly, finding new ways of dealing with this matter requires tremendous cooperation among departments and our provincial colleagues.

The Chairman: Thank you very much.

[English]

Ms. Wasylycia-Leis, please.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Thank you, Mr. Chairperson, and I'd like to also thank Madam Fortier for her presentation.

What I'd like to do is start with a few questions on the HPB transition and begin by asking at what stage the HPB transition project is at.

Ms. Marie Fortier: Ian can answer in more detail, but I can tell you it's a process that is not completed yet. One of the end points of it—it's not the only one—will be the tabling of new legislation for the health protection branch. And we're not there yet. I think that like all change processes, it's one that, as it's going on, begins to have results. But the full results you can only judge after it's all completed. I believe we're more than halfway there, and I'm sure Ian can answer in much more detail what steps are involved at the moment.

Ms. Judy Wasylycia-Leis: Further to that, Mr. Chairperson, I appreciate the response and the indication that it's a work in progress. I'd like to therefore ask why, in a memo dated November 9, the deputy minister indicated clearly, “It is time to operationalize the transition results by integrating this activity in our day-to-day operations”. He goes on to further indicate the departure of Dr. Losos, or the fact that he's staying until May 1, 2000, and will see you through the implementation components of the HPB transition.

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Ms. Marie Fortier: I appreciate the question, because I had a hand in writing that memo. David Dodge and I were intending, first of all, to announce a number of staff changes in the department, one of them brought about by my move from the policy branch to this job.

In saying that, all we want to signal—and it's nothing earth shattering—was precisely what I referred to, that it is a process, and that as we gain a better understanding of the changes as new resources become available to the department, we mustn't see transition as something that is happening completely outside of ongoing activities. On the contrary, there's a need for gradually merging the day-to-day work and the new thinking around how to be up to date in our science base, how to make decisions that are sound, and how to manage the decision-making processes as transparently and openly as possible.

Ms. Judy Wasylycia-Leis: Again, on the same issue, the public was involved in a consultation process around HPB transition. Based on my own personal experience in attending some of those sessions, as well as the report of your department about those consultations, there's a great deal of concern about HPB transitions. So I'm still curious to know why you would begin even a partial implementation of so-called HPB transition, given the fact that the public, as acknowledged by your own department, is very concerned and has expressed very strong reservations about the process.

Ms. Marie Fortier: I think transition has become code for some people for certain things. We're really talking about implementing change in a branch that has experienced a serious reduction in resources over a number of years and, as a result, has not had the opportunity to renew itself as organizations must do constantly.

There certainly are people who have concerns; there's no doubt about that. I'm sure that even at the end of the day there will be different views about the right way of managing health protection activities for a given country. We'll never reconcile all those differences.

But Ian will talk to you in a few minutes about health protection and what this change really means, bringing the branch up to standards today. It means improving our knowledge base. It means having a clearer and more understandable process for making decisions and gradually improving the understanding of that by the public we're serving.

That's what transition is. It's nothing more and nothing less. But it's very encompassing for a branch that is dedicated to knowledge, that is highly science based, that not everybody understands, and it's not easy for management and scientists to gain a common language and a common understanding. So all of that is at play here.

I believe we've not finished. As I said earlier, we're not all the way there, and there will be more opportunities for public input into decisions. But I would really defer to Ian to complete this discussion with you.

Ms. Judy Wasylycia-Leis: I have one more question.

Again you said that the process is ongoing and you're only halfway there. Why, then, would legislation have been introduced in the House addressing a fundamental aspect of the role of the health protection branch, which of course pertains to food safety?

Bill C-80, which was introduced last spring, hasn't been reintroduced yet in this session. It is, however, a fundamental part of this reshaping of the role of the health protection branch, and clearly part of that transition, whatever that means... I'd certainly love to hear what it means, what we're making a transition to, in very clear terms. But if we're only partway through, why was legislation introduced? Surely we have a process, we involve the public, we wait for the results, we address those concerns, and then we make decisions based on that. Doesn't this just create more cynicism among the public?

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Ms. Marie Fortier: As we've done in other areas such as blood safety, when you come to a conclusion on an aspect of the review of a large organization, there's no reason not to proceed with that aspect rather than have everything wait for everything else to be ready to go forward.

Ms. Judy Wasylycia-Leis: But if I could just interject, food safety is a fundamental part of the health protection branch. That is all part of the whole consultation process and the so-called HPB transition. How can you separate out a fundamental aspect and say you're going to move forward on that, when the public has spoken and your own reports acknowledge the public's concerns in that regard?

Ms. Marie Fortier: As you know, the food act is not just about health protection branch. It pertains to a broader set of agencies, the CFIA primarily. So there was a judgment made at the time by the government that it was necessary and timely to act in this area. It has a bearing on health protection branch, but a fairly limited one.

Again, Ian, perhaps you can join me, because I really wouldn't want to mislead the members.

The Chair: We will get into that in a minute. Perhaps we can answer that at that time.

But Ms. Ur has the last question, and I know you have to leave, so we'll get to that right now.

Mrs. Rose-Marie Ur (Lambton—Kent—Middlesex, Lib.): I'll quickly follow in my colleagues' questioning.

How many dollars in personnel are devoted in the department to food issues, agricultural issues? Do you have a breakdown as to that?

I'm a little concerned when you state here that your key issues are native health, medicare and wellness. Where does agriculture, food safety and that come into those three brackets? It just seems to be lost in this shuffle between agriculture and health. As Judy has said, in food safety, it is vital that we maintain what we have. So how much time and effort do you really spend on that?

Ms. Marie Fortier: Just to situate it properly, it's very clear to us that food safety, as well as drug safety, environmental health, and other considerations such as disease control and health promotion, are all part of this broad umbrella called wellness, which includes all the factors that impact on the health of people. Many things are part of that, but they all deserve attention in their own right. Our grouping them together is certainly not an attempt to trivialize them.

As to exactly how much, I'm sure Ian can answer; I don't have the number in my head. I'm not even sure you have it with you today, but—

Mrs. Rose-Marie Ur: Maybe you misunderstood my question. How many people working in that department actually understand agricultural issues?

It's well to talk about drug safety and environmental health and everything else, but quite often we have bureaucrats working in there who have no concept of the grassroots input of what goes into agriculture or food safety. It's all well and good for the top people to tell us what to do in the agricultural sector when they have no idea what is actually going down there. So you have to have the connection with the bureaucrats and health, as well as the grassroots people. With some of the decisions that have been made previously, I think there was a bit of a void there, and I wonder if there are actually experts working in Department of Health who have that kind of knowledge base.

Ms. Marie Fortier: Thank you. If you don't mind, I think I'll leave that to Ian.

Mr. Ian Shugart (Visiting Assistant Deputy Minister, Organizational Renewal, Health Protection Branch, Health Canada): Mr. Chair, I can try to address that.

We have in the food directorate about 450 employees, so it is in fact a very sizable group of people who are primarily concerned with the science and the policy and standard-setting for food safety. That is one point.

The second point is that while in 1997, with the creation of the Food Inspection Agency, we did transfer about 200 inspectors to the CFIA, that was in fact the smallest contribution compared to Fisheries and Oceans and Agriculture Canada, who also sent inspectors to the new inspection agency. In fact that did not begin a practical day-to-day division between the two agencies. The reality is that on the ground, day to day, there is very close collaboration between the food directorate, the Laboratory Centre for Disease Control, and the Canadian Food Inspection Agency.

• 1205

I agree entirely with you that we need to have a fully vertically integrated approach, right from what happens at the farm all the way up to the standards that are set for food producers and industry. The modern reality is that the whole world community, in terms of food safety, acts very frequently in concert to ensure that food safety is a multi-jurisdictional thing, because of the extent of modern trade in agricultural products.

The Chair: Ms. Ur, be very quick.

Mrs. Rose-Marie Ur: Thank you, Mr. Chair.

I found it very interesting, in a response to one of my colleague's questions, when you stated that it's hard to draw clear lines to see if there is duplication in different departments. Is that an indication that the department is branching off into so many branches that the left hand really doesn't know what the right hand is doing, and everyone wants to maintain their own little fiefdoms, so they can collect their paycheques at the end of the week?

Ms. Marie Fortier: Not at all. At least that's not my evaluation of it. I was referring more to the danger of trying to create watertight compartments between departments' mandates, and the risk that some issues that don't fit so neatly in either compartment might wind up being untreated and misunderstood, or just left aside.

Issues are so complex, whether you take seniors, children, aboriginal health or whatever, and there's such an interplay between different actions and reactions that we find it's better to work in collaboration, rather than trying to take our own little piece of the problem, go away and solve it independent of each other.

The Chair: Thank you, Madam Fortier. If you could introduce the other people who will be presenting before you leave, I think it would be appropriate.

Ms. Marie Fortier: Ian Shugart is the visiting ADM in the health protection branch. Even though in our earlier schedule medical services were to be next, it might be just as easy to continue on the theme of health protection. Ian Potter will be speaking on health promotion and services, and Monique Charron will be speaking on medical services branch issues. Joel Weiner is accompanying Ian, and he's also from the health protection branch.

The Chair: Thank you very much.

Ms. Judy Wasylycia-Leis: Before Madam Fortier goes, could we ask her to table with the committee some information that I think would be useful for our work?

The Chair: Such as?

Ms. Judy Wasylycia-Leis: I understand that all branches of the department have undergone an impact review, looking at their objectives, the impact of programs, and the need for any changes in the future. I'm wondering if you could ask Madam Fortier to table with the committee a copy of the impact review for each of the branches in the department.

The Chair: I'll take that under advisement and get back to the committee next week.

Ms. Marie Fortier: Thank you, Mr. Chairman.

The Chair: Thank you very much for your time.

Mr. Ian Shugart: I'll pick up where the associate deputy minister left off in her remarks. She described the department and then touched on how that relates to the theme of wellness, as we've been speaking of it. I'll begin the other way around, if I may.

Members will be aware that historically major advances in the health of the population have come from the introduction of clean water, measures like immunization, access to proper nutrition and so on. In the Industrial Revolution, which in some ways is reminiscent of what we're facing now, the quality of air was having a very major negative effect on the public. As society adjusted to the Industrial Revolution, making clean water, taking measures to prevent serious air pollution, introducing child welfare laws, and so on boosted enormously the health of the population.

• 1210

I mention that because today the work of the health protection branch ties into that of other programs in Health Canada by addressing, in our case, public health interventions to boost the overall health of the population and indeed to maintain it. Many of those advances have been maintained. It's our mission particularly in health protection and in public health to ensure that health status is not put at risk.

We do that in a number of areas. An example is infectious disease control. Also, increasingly we need to address issues of aging, as Monsieur Patry mentioned. And we need to build the knowledge base for the most effective interventions in chronic disease control. We do that through ensuring safety and efficacy of drugs and medical devices, ensuring safe food and safe consumer products, as well as intervening in support of a clean environment.

We are perhaps the most heavily science-intensive part of Health Canada. Typically that has been the sciences of human epidemiology, of public health, and of the laboratory. We know we need to broaden out beyond that into more social sciences and we need to have a more seamless approach to science throughout the department.

Our science is typically very applied science, and it goes hand in hand with very extensive resources in public health surveillance. Both of those—the bench and other sciences and the public health surveillance—combine to give us the knowledge base, which is then transferred into regulation. We're a substantial regulator, not only in Health Canada but indeed among departments in the federal government.

We use that knowledge base for policy- and standard-setting for others. For example, the relationship between us and the Food Inspection Agency is largely along those lines: we set the standards and the policies, and the agency is responsible for compliance and enforcement.

Ms. Wasylycia-Leis referred earlier to the Food and Drugs Act. In fact the fundamental relationship that was established at the time the CFIA was created is confirmed and made clear in the Food and Drugs Act: that our responsibility is in the policy- and standard-setting. But we also assist provinces and territories in that regard. Also, we provide direct support to professions and to the public health authorities across the country when, for example, there are outbreaks of infectious illness.

So it's a highly knowledge-intensive program as well as having a variety of interventions. We do that in four programs. One is the therapeutic products program, responsible for the approval or rejection of drugs, new medicines, and medical devices for which application is made by industry. We also do that through the food program, which I've just touched on. And we do that in the environmental health program and the Laboratory Centre for Disease Control.

In addition, we have a small group headed by my colleague Joel Weiner, the policy, planning, and coordination directorate, which is the point of integration or coordination for much of our regulation-setting as it works through the system—biotechnology, public participation, and so on.

I don't want to take more than another three or four minutes in describing the transition process that has already been touched on this morning.

• 1215

We had from the outset indicated that the formal part of this process would last between two and three years. In August 1997 I began my assignment in the department as a visiting ADM working with Dr. Losos, who actually runs the branch on a day-to-day basis. So at the moment we're about two and a quarter or two and a third years into that period.

We knew the process of adaptation and change would go on, that it did not have a best-before date. In the judgment of the department, the point has arrived when increasingly we have results from some of the work we've been doing internally and externally, and the way ahead, for example in science and in surveillance, is fairly clear. We need now to put the emphasis on implementing that and operationalizing that.

There are other parts that clearly aren't done, as has been indicated—the legislative renewal and so on.

Let me touch, if I may, on a few highlights. I would be pleased, at your invitation, to either provide written materials, which are on the public record in some abundance, or come back to the committee to provide further information.

We set out to do work in five areas.

One is the science base, where our philosophy is the following. We know that in the world of modern science, which is vast and very fast-paced, we cannot do it all in-house. So we have selected a number of high-priority areas where we are going to increase our debt. These would be in the areas of genetics, for example, in order to prepare for the growing onslaught of products based in biotechnology; enteric diseases, which are gastrointestinal kinds of diseases; and diseases that are borne by animals and transferred from animals to humans, which is a growing concern in health science.

I referred to biotechnology, but there are other related areas, such as anti-microbial resistance, where we have real concerns about public health impact and so on. Then there are a couple of areas where we really want to use the resources we have, such as the new Winnipeg laboratory, to make the kind of contribution we can make to the global body of knowledge in our own right. By building in those areas, we can then have strengths on which we collaborate with science outside the branch.

The second area is public health surveillance. In June, for the first time in Canada, we had a federal-provincial-territorial agreement with all jurisdictions to collaborate in a new, coordinated way on public health surveillance, which has been fragmented and spotty. There has been a lack of standardization in this area. All jurisdictions have recognized the benefit of investing together in this and have come together to establish a network for health surveillance in Canada.

We've been looking at all our programs with an emphasis on two things. First of all, what's the right level of investment? We've been making recommendations to the department and the minister in that regard. Also, we're looking at the delivery of these programs. Part of that is to sort out the accountabilities. We do want to avoid duplication, but we want to ensure there is enough of a connection between the various players in public health that things don't fall between the gaps.

We've been strengthening our risk decision-making. Part of that has to do with the theory and the analysis of risk management and how decisions are made about risk. Risk management is essentially synonymous with risk decision-making, and we've tried to build in some greater internal disciplines. I can describe those if you wish.

• 1220

Finally, in the legislative renewal project, after a first round of consultations, we have been working through the many technical aspects of our health protection. We have about 12 separate statutes.

[Translation]

For the benefit of the members, we could submit to the committee a list of these statutes along with the text as such.

Once we have completed the legislative renewal process, we will undertake a second round of public consultations,

[English]

and only at that point would we begin the formal legislative process itself.

I'll stop there and defer to my colleagues. That's a lot of ground to cover, and I realize it's an area of high interest. To repeat, we'll be at your disposal for further background.

The Chair: Thank you, Mr. Shugart. You mentioned some written material that you'd make available. I think that would be appropriate. I saw some heads nodding, so I think that is something we'd look forward to.

We have to keep an eye on the time here. We have about 35 minutes left, and we still want to get questions in. So, Madame Charron, would you please keep it reasonably brief.

Ms. Monique Charron (Director, Program Policy and Planning, Medical Services Branch, Health Canada): Thank you, and good morning.

I'm pleased to have the opportunity today to appear before the committee. I'm here to speak to the issue of first nation and Inuit health and explain, first, the health needs of this population; secondly, the mandate and activities of the medical services branch of Health Canada; and thirdly, the branch's strategic directions for addressing these needs.

[Translation]

As Ms. Fortier mentioned, the reasons for the poor health of aboriginal peoples are complex. Many communities and groups have made significant progress on the education front and the rate of infant mortality and substance abuse has declined considerably.

[English]

However, as stated by the Royal Commission on Aboriginal Peoples in its final report, notwithstanding that medical services are now delivered to aboriginal people even in the remotest parts of the country and that some causes of morbidity and mortality have been brought under control, the gap in health and well-being between aboriginal and non-aboriginal people remains stubbornly wide.

The royal commission report identified numerous strategies to address aboriginal health, including increased support for self-government, improvements in the basic prerequisites for health, such as access to safe housing, and improvements in health services, such as increasing the number of aboriginal health professionals.

The federal government is continuing to build on the strong foundation of reconciliation and renewal created by Gathering Strength—Canada's Aboriginal Action Plan in responding to the report. Federal commitment has focused on strengthening economic opportunities and improving the living conditions of aboriginal people.

For Health Canada's part, we are continuing to work with aboriginal communities to improve health services and address health needs.

The Second Report on the Health of Canadians, which was mentioned by Madame Fortier, summarizes the most current information we have on the health of Canadians and the factors that influence or determine health and wellness. It suggests several priority areas for action in the new millennium, including action to improve the health of Canada's aboriginal people. The first nation infant mortality rate is twice that of Canada as a whole, and first nation and Inuit infants are at greater risk for negative birth outcomes, such as fetal alcohol syndrome and fetal alcohol effect, and HIV-AIDS.

For a significant proportion of first nation and Inuit women, the experience of pregnancy, birth, and the first year of the baby's life are difficult and put the mother, infant, and family at risk. Aboriginal children in some communities are more likely than children in the general population to begin at a young age adult behaviours such as smoking, drinking, and drug use. We know diabetes is one of the leading causes of illness, disability, and death among first nations. Current evidence shows that diabetes is three times that of the general population.

Aboriginal people face a number of disadvantages in the underlying factors or determinants of health. Compared to Canadian families as a whole, a greater proportion of aboriginal families experience problems with housing and food affordability. Health problems are linked to high unemployment, pervasive low incomes, and other social factors.

• 1225

As Madame Fortier explained, MSB has a client-oriented focus, and it provides or funds non-insured health benefits and community health programs for first nations and Inuit. The branch's goal is to transfer control over these health programs to first nations and Inuit within a timeframe to be determined in consultation with them.

MSB ensures the availability of or access to health services for status Indians and Inuit. It also assists these communities in addressing health inequalities and disease threats to attain a level of health comparable to that of other Canadians living in similar locations.

[Translation]

The Branch provides health services to status Indians living on reserves and to First Nations and Inuit communities . These services are delivered and administered by regional offices and by a network of hospitals, nursing stations, health care centres and other health care facilities, most of which are located in remote, isolated areas.

[English]

Two major programs are provided—community health programs and non-insured health benefits—at approximately $1.1 billion annually.

Community health programs support treatment and public health services to first nations communities. Programs include, for example, nursing, communicable diseases, environmental health services, and alcohol and drug abuse programming. The program also operates a scholarship and bursary program designed to increase the number of aboriginal people pursuing careers in the health fields and in the aboriginal head start on-reserve program.

The non-insured health benefits program provides a range of health-related goods and services, such as drugs, a dental program, vision care, medical equipment and supplies, and medical transportation, to first nations and Inuit.

MSB pursues three goals in its attempt to improve first nations and Inuit health: first, the development of sustainable health systems that are well integrated into the Canadian health system; second, the reduction in health inequalities experienced by first nations and Inuit; and third, strong partnerships with first nations and Inuit to create the needed and desired changes in the health system. These goals are pursued within the overarching vision of control and autonomy of health services by first nations and Inuit.

Budget 1999 announced several new initiatives that supported these goals. A key budget initiative supporting sustainability is the investment in a first nations health information system. This will provide a health information system, with accompanying training and capacity-building, to over 600 first nation communities. This will increase the capacity in these communities to undertake disease surveillance, patient management, and health service planning. Working jointly with first nations, our aim is to equip communities with the infrastructure and capability to monitor health trends, plan appropriate strategies, and report health outcomes.

The issue of accountability was raised earlier on in the committee. This is one of the tools first nations had been asking us to have in their first nation and Inuit health system to address the sustainability and accountability of their system. In my experience, different communities have varying capacities to deliver programs, and definitely some communities struggle to deliver those services. The key, from work we've been doing with first nation and Inuit health partners, is to look at building the capacity of those communities to deliver those programs. This is one of those key tools we feel will help communities address that issue.

In some other work we're doing on accountability, we've been working with our first nation and Inuit partners to look at how to improve shared accountability frameworks—that's to say, accountability both to their community and to the federal government. Work is very active on that right now.

A second major budget initiative supporting the goal of sustainability is an investment in a home and community care program for first nations and Inuit. The home care initiative aims to fill gaps in the continuum of care.

• 1230

First nation and Inuit home care will provide improved care for the elderly, disabled, chronically ill, and those requiring short-term acute care services. It will enable elders to stay longer in their communities and increase opportunities for elders to pass on tradition and culture.

Several other components of the budget take action on health inequalities experienced by first nations and Inuit. This is where we try to balance the health equation, as Madame Fortier mentioned, by addressing both wellness issues and health system issues.

Health Canada is currently putting in place strategies to address the growing problem of diabetes in the Canadian population, the most vulnerable of whom are aboriginal people. The aboriginal diabetes initiative will provide culturally appropriate prevention, education, treatment, care, and improved surveillance. It will be pursued jointly with aboriginal partners.

The federal government is also increasing funding to prenatal health. An important element of this initiative is a focus on first nations and Inuit women and infants. This initiative, together with the recent aboriginal head start on-reserve program, are significant building blocks to issues in children's health and wellness.

Within prenatal health funds, the issues of fetal alcohol syndrome and fetal alcohol effects will also be addressed. New funding will provide improved public education and treatment models as well as research into early identification and best practices in prevention and treatment.

[Translation]

These initiatives build on the accomplishments of First Nations and Inuit communities and support the changes communities face in meeting new challenges, developing new approaches to service delivery and building the resources to become more effective.

[English]

As is consistent with our efforts to renew medicare and the Canadian health system generally, these investments promote an integrated first nation and Inuit health system, providing a more complete continuum of necessary care for first nation and Inuit communities.

First nations have identified their health priorities, and together we are acting. The federal government is taking steps to act on that gap between first nations and the larger Canadian population. MSB is working together with first nations to take action on urgent health concerns and to build community-based capacities that will result in longer-term improvements to the health of individuals, families, and communities.

[Translation]

The Chairman: Thank you very much, Ms. Charron.

[English]

Mr. Potter, if you would, please.

[Translation]

Mr. Ian Potter (Assistant Deputy Minister, Health Promotion and Programs Branch, Health Canada): Thank you, Mr. Chairman. I'm very pleased to be able to give you an overview of the department's Health Promotion and Programs Branch.

[English]

In the interest of time, I will try to deal with some of the highlights of the work of the branch.

First I'd like to talk about the branch mission. The mission of the branch is to enable Canadians to take action on their health and the factors that influence it. Within that, we have three particular roles. The first is to promote an understanding of and action on the broad determinants—that is, to explain to the population and public in general and to specific groups what makes people healthy and what makes people ill.

To that end, it would be a pleasure for me to send copies of a recent report that was released by the federal, provincial, and territorial ministers of health, called Towards a Healthy Future: Second Report on the Health of Canadians. This report is a full documentation of the issues. It's a picture of the health of Canadians. How healthy are we today? What are the illnesses and what deficiencies do we have in our health?

As well, it goes through the determinants of health. It assesses the impacts of various determinants on health—the various things that affect people's health. For each area, it examines gender and age as they affect health. It looks at the impact on health of income and income distribution, the social environment, education and literacy, the physical environment and how it contributes to our health or illness, personal health practices, health services, and biology and genetics. For each one of those areas there is a fairly comprehensive analysis of the impact of these basic facts on health. It would be my pleasure to circulate that to the committee.

• 1235

The branch also works to provide national leadership, to address specific populations or specific health issues. We're responsible in the branch for coordination of issues around children's health and the health of seniors. We also take the leadership on certain disease prevention strategies, such as the prevention of HIV and AIDS, breast cancer, and heart disease.

The department also works to provide some support to communities to manage their own health issues. To that extent, we manage what we call a population health fund, which provides grants and contributions to local organizations to mobilize their efforts to deal with health and improve the health circumstances of their communities.

I'll touch on a few areas of work. I've mentioned our work in child development. I'll also touch on our work with seniors, some emerging health issues, and population health.

On our work on children, Health Canada has been a very active participant in a federal-provincial-territorial exercise that Dr. Patry referred to earlier, which is the national children's agenda. You may have this document; if you don't have it, I could circulate it.

This document was put out by the Federal-Provincial-Territorial Council of Ministers on Social Policy Renewal and led to a consultation over the summer. It put forward a vision for where we're trying to move on a children's agenda. It talked about some of the areas of priority and identified some initiatives that the research had identified as important.

The working group that put this together—and I think it addresses the issue of whether there is overlap or duplication—was a federal-provincial-territorial working group that represented sectors in health, social services, education, justice and others. It looked at what we needed to do in order to more effectively provide the services to result in good outcomes for Canadian children.

One of the initial conclusions of that working group was that success required the working together of these areas. It was impossible to succeed if you were only working in the area of education or health; the interaction of these areas was so strong that it was an essential aspect.

The other conclusion was that it was not something one government or governments alone could do. In order to be able to move forward in an agenda on children, we needed the collaboration of federal, provincial, territorial and municipal governments, local communities, the private sector, unions and many others, because a good child policy requires that kind of integration.

Health Canada also manages a couple of programs, such as the community action program for children, or CAPC, which is a Canadian prenatal nutrition program. These programs are run in conjunction with provincial governments. We have an extensive network of communities that we serve. They contribute in a way to a broader agenda of improving the development of children.

One of our motivational aspects is the conclusion of many of the experts. A recent report by Fraser Mustard and the Honourable Margaret McCain, former Lieutenant Governor of New Brunswick, indicated that the developmental period of zero to three, zero to six, was critical. We have been looking at our programs to try to improve them.

I will move on to discuss our work on seniors. This is the International Year of Older Persons. Health Canada has been the lead department, and my branch has been actively supporting work to recognize the contribution of seniors, recognize the needs of seniors, and to try to build in work that would provide the foundation for looking at an aging society.

• 1240

We had a very active committee that had discussions with groups across the country. Out of that work we have put forward—and it has been endorsed by federal, provincial, and territorial ministers—a national framework on aging, which is a policy document that would help departments in making decisions with respect to their programs and their impact on seniors.

We are also very cognizant of the fact that the aging population will put stress on Canadian society and on the health care system, and we recognize that we can do things about it. We know that health promotion and disease prevention can reduce the incidence of non-communicable diseases such as cancer, osteoporosis, hypertension, and cardiovascular disease, and we are initiating programs now that can manage that.

An example of that is the Guide d'activités physiques, which has been recently published by the department. We have made millions of copies available to schools and individuals. This is based on the most up-to-date information on how this can keep you healthy. We know that active living—physical fitness—not only can contribute to your health, but can reduce diseases such as cancer and cardiovascular disease.

We have recently added to our branch a director in charge of rural health, Dr. John Wooton, who is looking at integrating our overall programs so that we can more effectively meet the needs of a rural population.

Finally, I'd just like to mention that we're working on empowering the public. It will be launched soon by the minister in a very public way, but it's actually been up and running. We have an extensive series of partners in the development of something we call the Canadian health network.

This is an Internet-based health information system that is intended to allow individual Canadians to get, in an easily organized fashion, access to comprehensive information on their health and to know that it's reliable, it's certifiable, and it's the best information that medical science can give. We have over 400 partners across the country working on this so that Canadians will be able to turn to a trusted source of information when they're looking at their health issues.

Thank you, Mr. Chairman.

The Chair: Thank you very much, Mr. Potter. I think we may not have seen some of those publications, especially the one on children. If you could make sure that all members of the committee are circulated, that would be appropriate.

Mr. Grewal will start off. Knowing that we're soon to be out of time, and because it's in the second round, we'll keep it to three minutes so that everyone gets a chance to question.

Mr. Grewal.

Mr. Gurmant Grewal (Surrey Central, Ref.): Thank you, Mr. Chairman.

Thank you very much for the presentations.

I wanted to put my question to the associate deputy minister, Madame Fortier, but she left without the question.

I have two quick comments. One is about the mission of Health Canada, which is to help the people of Canada maintain and improve their health. I think what I'm hearing from my constituents is that generally we are offering these services to sick people, so it is a sickness care system more than a health care system for improving the health of people.

Having said that, I want to be very upfront. One of the serious problems that we notice is the morale and confidence level of the health care providers in the system. One of the reasons is probably the impact of the cuts in the health care system that we have seen for last six or seven years. About 1,400 doctors left Canada last year. Also, 6,000 nurses left Canada last year. Beds are closing, as we know, and waiting lists are growing. There are probably 2,000 people on waiting lists.

I know this question is not directly related to the presentation, but maybe one of the two assistant deputy ministers can answer it. The question is, what is being done to reverse this trend and boost the morale rather than letting the morale decline, as is happening with the health care providers?

• 1245

The Chair: Who wants to take that? Mr. Potter.

Mr. Ian Potter: My apologies for not knowing precisely the answer to this area. It's not my area of responsibility. But I do know the issue is very much on the forefront of the work of the department.

The federal, provincial, and territorial ministers of health met in September, identified the issue of the health human resource question—the adequacy, the numbers, the morale, and the need to have an effective utilization of that—as one of their top priorities. They asked the Advisory Committee on Health Human Resources, which is a federal-provincial-territorial officials committee, to accelerate their work. They are expected to have reports in for deputies' consideration in December.

There was also a commitment by ministers to arrange to meet with the two major professional organizations that represent physicians and nurses. I believe that's likely to take place before Christmas.

The Chair: Thank you very much.

Monsieur Ménard.

[Translation]

Mr. Réal Ménard: Could you tell us a little more about your branch's resources? I believe HPPB is responsible for drug licensing. Could you compare for us the process followed here in Canada with that followed in the United States? What measures do you intend to take to make the process more stringent and effective?

My second question concerns the Population Health Fund. According to my sources, the amount in the fund totals nearly $1 million in Quebec. Isn't it a little ridiculous to have us believe that this program can truly be of benefit to people? I've met many people who want to submit project proposals for funding under this initiative, because it is the largest source of project funding available. The aims of this program seem somewhat nebulous and your resources somewhat limited. Would it not be wise then to review this entire initiative?

Mr. Ian Shugart: I'll answer your first question and let Mr. Potter field the second one.

Health Canada's Therapeutic Products Program operates on an annual budget of about $60 million. I have no idea how much the U.S. Food and Drug Administration spends on similar initiatives. The drug licensing review process is basically the same in all industrialized countries. A private company files an application containing information about the scientific process on which the product is based. Our program evaluators analyse very thoroughly the data they receive. Drug regulatory agencies cooperate internationally on this front.

[English]

We have done our best to ensure that review process is as efficient as possible. Within the means we have at our disposal—and we've commissioned a review of this externally—our review times are similar to those of comparable agencies.

[Translation]

Mr. Réal Ménard: How many departmental employees are involved under the Therapeutic Products Program in the review process?

Mr. Ian Shugart: Approximately 700 people.

• 1250

Mr. Réal Ménard: You say that your department has 5,510 employees in total, 700 of whom are involved in the review process under the Therapeutic Products Program. Would you be willing to bet a large draft on that?

Mr. Bernard Patry: I'll wager with you.

Mr. Réal Ménard: I know you like beer, Bernard, but it's bad for your health.

[English]

Mr. Ian Shugart: The areas they cover are new drugs, medical devices, and the regulation of the blood system, so biologic products such as vaccines, blood, and so on. They are responsible for the review of products as well as the establishments where they are manufactured. So, for example, there is inspection of the facilities that underlie the blood supply, there is inspection of lots of vaccines coming through the system, and so on.

So it's a very large field of products that come under the therapeutic products program.

The Chair: Thank you, Mr. Shugart.

If there's something further to add, Mr. Potter, perhaps you can do that in writing, and we'll get that. We really must move on.

Monsieur Patry.

[Translation]

Mr. Bernard Patry: Thank you very much.

[English]

I have a couple of comments to make very quickly, because Rose-Marie also wants to ask a question.

Mr. Potter, I was very pleased about your answer regarding a national children's agenda and also the aging of the population. Just to let you know, a little committee I work with John Godfrey on is meeting with Buzz Hargrove this week, which means even the unions are part of this right now. That's very good.

[Translation]

Ms. Charron, you mentioned the poor health of members of First Nations and Inuit communities. I served for two years as Parliamentary Secretary to the Minister of Indian Affairs. Sometimes, there are very simple things that Health Canada can do to improve the situation. Just acknowledging the problems associated with fetal alcohol syndrome would be a major step. I have to wonder about the willingness on the part of the government and of the department to act on this matter. Sometimes, the solution lies in taking very specific, concrete action.

[English]

Mr. Shugart, there's one thing you didn't mention, and it's about GMOs. I think GMOs will become very important in the next year or two. It seems the health department is not looking at this or they don't want to take the lead on this. It seems Agriculture is taking the lead, and it seems the department is saying if we talk too much about this, it's going to be harmful to agriculture, and I mean the exportation of agriculture. If we don't take care of this, we're going to have problems.

That's my question, and I know Rose-Marie wants to ask one.

The Chair: Ms. Ur, ask your question.

Mrs. Rose-Marie Ur: Do you have any data available as to the impact, if there was any impact, of the social transfer of the health dollars that were cut back to the provinces? I'm not being political about this. I want to know from your department if there was actually any negative impact, or is this just an area where people can point fingers at another level of government? If you can produce it—

Mr. Ian Shugart: We will review what we have available, both internally and from other sources, and try to provide what analysis there is on that question.

Mrs. Rose-Marie Ur: We'd appreciate receiving that.

The Chair: That would be very good. Thank you.

And to Mr. Patry's question?

Mr. Ian Shugart: I agree with you that this is an area that has enormous consequences for the future and is very sensitive in the public. Our position as Health Canada on this issue is that while it has many facets, our job is the health and safety of the public as a result of these products.

The process—which again we could provide in fuller detail at another time—does scrutinize these. We've called them novel foods; they're essentially new, biotechnologically produced foods. For any new product, whether a drug or a food additive, the information in assessed. There is international exchange of that information to ensure we're not missing that other countries are asking. We give those products the greatest proper possible scrutiny we can.

This area is exploding, and we are going to have to be very attentive to it.

The Chair: Thank you very much.

Wrapping it up, Ms. Wasylycia-Leis, please.

Ms. Judy Wasylycia-Leis: Seeing as no one else is here, maybe I could just ask for another half-hour. Could we extend the meeting?

The Chair: How about a half-minute?

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Ms. Judy Wasylycia-Leis: I'll ask five questions in 30 seconds, and that'll leave two and a half minutes for a response.

The first has to do with first nations health care. Last year's budget committed $190 million. I'd like to know how much has been spent to date and on what.

The second question has to do with therapeutic drugs and the fact that the department may be lifting restrictions on the direct-to-consumer advertising. What's the status of that?

The third question has to do with the shortfall in the food directorate research capability, which we clearly know is the case from previous testimony and from the letter signed by 200 scientists. When will that shortfall be addressed, and when will the food directorate be fully recommissioned?

The fourth question has to do with the critical report by the European Union about the capabilities of our veterinary drug research bureau. Part of that also was a letter from the CFIA back to the department asking when the department will enforce its own laws to ensure we don't have to leave consumers in doubt about the safety of our foods.

My final question has to do with Marie Fortier's earlier response suggesting that other agencies and departments are responsible for food. I would like a comment on the understanding that in fact the Minister of Health has a statutory obligation under the Food and Drugs Act to ensure the safety of all foods as well as drugs and medical devices. Is that still the case? How does the department justify the movement toward a risk management model in the face of that statutory obligation?

The Chair: Ms. Wasylycia-Leis, those are five excellent questions. I don't think we can do justice to them in the time remaining. I'm wondering if the department can think about those questions between now and tomorrow and perhaps bring back a written response, which we can circulate to all members. If further elaboration is needed at that time, we can hear it.

I understand that most, if not all of you, will be here again tomorrow. Is that correct?

Mr. Ian Shugart: As I understand it, Mr. Chair, we will be hearing from the other three branches of the department.

The Chair: I understand that you'll be here as individuals on standby in case there are questions.

Mr. Ian Shugart: If you would like us to be here, we will accommodate that and perhaps have the program people who can speak with greater precision to some of the questions. But we can arrange to have all three branches represented—

The Chair: It just seems to me that we can't give justice to those good questions.

Ms. Judy Wasylycia-Leis: We have a minute. Could we not at least see what they're able to answer of those five questions?

The Chair: Sure, we can start if you want. That's fine. I'm just trying to help you out.

Ms. Judy Wasylycia-Leis: I'd like to start. We may not get to it tomorrow.

Ms. Monique Charron: I can provide some preliminary information on the $190 million that was allocated to first nations in budget 1999. That $190 million is over a multiple-year framework.

Ms. Judy Wasylycia-Leis: I want to know for year one.

Ms. Monique Charron: For year one, this fiscal year, it was approximately $25 million. I can get the precise figure for you. We're more than halfway through the fiscal year, so we've been doing investment.

Mr. Ian Shugart: Mr. Chairman, maybe I can make two or three quick points that will address, though not fulsomely, some of the questions raised.

The food directorate is in fact fully operational. The cuts that had been proposed have been reversed. Those programs are underway.

Let me assert that the department does have responsibilities with regard to food safety. As I indicated, the primary division is between the standard-setting and the policy-setting, for which Health Canada continues to be responsible, and the enforcement and compliance function, which is that of the Food Inspection Agency. The petition by the 50 or so scientists and others takes exception to that configuration of our food safety system. But indeed both agencies have responsibilities and are jointly involved in that.

On direct-to-consumer advertising, the department is examining this. We have not taken a decision with regard to recommendations. We are balancing the consumer access to a flood of information in the Internet age with the somewhat more traditional stance, which is that this is highly technical information and the industry should not have undue access to consumers without going through proper channels and so on. That work is not yet completed, so I would refer the committee to the action plan for the Bureau of Veterinary Drugs, which again we could table with you as a response to your question about that particular sector of HPB.

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Ms. Judy Wasylycia-Leis: I just have a quick question for the purposes of the tabling of information.

The Chair: Very briefly, please.

Ms. Judy Wasylycia-Leis: Tomorrow, or whenever you're tabling this, could you also indicate what the follow-up is to the deputy's comments this summer about the department not being equipped to do research on genetically modified foods? Secondly, what would the reason be for why we wouldn't enforce section 5 of the Food and Drugs Act in order to require labelling of genetically modified foods, given the fact that they are a fundamentally altered product?

Mr. Ian Shugart: We can provide information on both of those. We may need a little longer than tomorrow to give you a good, useful response, but we'll undertake to do that in both those areas.

The Chair: Okay, why don't we do that, and we'll leave it at that. I think that's useful for all of us, and we'll circulate it accordingly.

Thanks very much for attending today. We look forward to tomorrow, of course. The health meeting is at 3.30 p.m. in Room 269, West Block.

There are not many members left, but certainly Ms Wasylycia-Leis is. For our edification, we expect Bill C-13 reasonably soon. As soon as that comes, we'll want to move expeditiously, so we may have to make some adjustments to the schedule. If the clerk is ready, she will put out a request for witness lists. If you have any that you need and/or want to have appear, please have the lists in by Thursday, November 18, if you would.

The Ottawa Hospital Loeb Health Research Institute has invited us on-site. We'll try to make those arrangements, because I think it's pretty much agreed—I've talked to members in advance of this meeting—that we can in fact go there and take a look at what they're doing.

Finally, there's a steering committee meeting Tuesday at 10 a.m., in advance of our ll o'clock meeting, in order to discuss future business and other items as they may occur.

Ms. Judy Wasylycia-Leis: Did you say that's on Tuesday?

The Chair: Yes, next Tuesday.

Unless I hear anything otherwise, this meeting is adjourned. Thank you very much.