FINA Committee Meeting

STANDING COMMITTEE ON FINANCE

COMITÉ PERMANENT DES FINANCES

EVIDENCE

[Recorded by Electronic Apparatus]

Thursday, October 18, 2001

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[English]

The Chair (Mr. Maurizio Bevilacqua (Vaughan—King—Aurora, Lib.)): I would like to call the meeting to order and welcome everyone here this morning.

In Halifax, as you know, the finance committee has been travelling across the country seeking public input on what should be the priorities for the upcoming federal budget.

We always welcome Canadians' input. In the past we have benefited a great deal from the insight that has been offered on a number of issues.

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The witnesses for today's panel, the first panel of the day, include, from the Nova Scotia Association of Health Organizations, Mr. Peter MacKinnon, CEO of Colchester East Hants Health Authority, Robert A. Cook, president, Mike Pennock, and George Kephart; from the Independent Living Resource Centre, Ms. Cecilia Carroll, chairperson, and Ms. Lois Miller, executive director; from the Newfoundland-Labrador Federation of Co-operatives, Mr. Glen Fitzpatrick, managing director; and Ms. Jane Warren.

Welcome to you all. As you've probably been told by the clerk, you have approximately five to seven minutes to make your presentations. Thereafter we'll engage in a question and answer session.

We'll begin with the Nova Scotia Association of Health Organizations.

Mr. Peter MacKinnon (Member of Board of Directors, Chair of Working Group, Nova Scotia Association of Health Organizations): I'll take the lead on this one.

Thank you very much for the opportunity to appear before you today. By way of background, I should explain that Mr. Cook and I are from the Nova Scotia Association of Health Organizations. Mike Pennock and George Kephart are members of the Population Research Health Unit at Dalhousie University. They will be referring to some of the work they've conducted around population health and the health system in our presentation today.

The Nova Scotia Association of Health Organizations is a non-profit, voluntary organization serving health provider organizations across Nova Scotia. That includes a broad continuum of care, including hospitals, district health authorities, nursing homes, home care, public health, addiction services, and residential and rehabilitation care facilities.

On a national level, NSAHO is a member of the Canadian Healthcare Association, CHA. I understand CHA met with this committee on October 2. I had a chance to see some of that presentation on CPAC. I hope we can push the agenda a little further with our presentation today.

To set the stage a little on where our thinking has come from on this, we all know that just yesterday Canadian troops sailed out of Halifax Harbour, directly behind this hotel, as part of Canada's new commitment stemming from the horrific events of September 11 in Washington and New York. Among the realizations that have hit us since that time is that our health system not only must be able to provide, on a sustained basis, adequate health services to Canadians, but it must also be prepared to respond to extraordinary events like the ones we've witnessed in the last month or so.

Those events reinforce the need to adequately fund the Canadian health system. In times of uncertainty, both economic and social, Canadians need the assurance that they will continue to have access to necessary health services on a need basis, not on the ability to pay.

Another realization that has hit us squarely is the vital role the federal government plays in protecting Canadians in the quality of life we enjoy. As I'm sure is quite apparent to everybody here, our health system is part of the fabric of Canadian society. While the economic forecast is unsettling and the full impact from September 11 is yet to be experienced, we can guarantee that Canadians will still require access to health services.

A strong federal presence is required so that Canadians, regardless of which province or territory they decide to reside in, can access comparable health services.

In the brief we presented to the committee there were a number of different points, but we wish to focus on two issues in our presentation to you today. The first is health as an economic investment. The second is a needs-based funding formula at the federal level.

First of all, on health as an economic investment, increased federal funding for health care and providing tax relief have often been presented as conflicting priorities. Our health system, however, contributes not only to individual and collective well-being, but also to Canada's economic performance.

Some of these comments mirror what the CHA has already put forward to you on this argument.

For example, companies that operate in Canada do not have to insure their workers' health in direct terms. This, in turn, is a major incentive for international corporations to locate in this country. If we are unable to sustain our current health system, the cost of insurance coverage will default to employers, as it does in some other countries, and employees. This would in fact constitute an increase in taxation and diminish Canada's economic advantage and competitiveness internationally.

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Consequently, NSAHO encourages the federal government to view its commitment to health funding as an economic investment, in addition to being an investment in the health of Canadians. I think we have evidence that making an investment in the health system not only looks after people when they're sick but actually helps to improve the health of Canadians. The recent report of the OECD indicates that Canada ranks well among OECD countries in terms of health status and mortality indicators, although there certainly is lots of room for improvement across the country.

The life expectancy of Canadians is one of the highest among OECD countries. Canada has one of the lowest smoking rates among adults of OECD countries, and the excessive consumption of alcohol per adult is much lower than is experienced in a number of other OECD countries.

The question, I guess, is whether more federal funding is required. Here in Nova Scotia, we say absolutely—or at least a look at how federal funding is provided. This province is struggling to maintain health programs that are equitable compared with those offered in other provinces. In some areas we're failing, or we could be characterized as failing. For example, long-term care, which is an insured service in the majority of other provinces, is not an insured service in Nova Scotia.

Based on that, I'll move forward to talking a bit more about a needs-based funding model. Try to bear with me on some of the statistical stuff I'm going to take you through. In 1999 spending on health care amounted to 39.3% of all provincial program spending in this province. This was the second-highest commitment of any provincial government, trailing only Ontario at 40.1%. There are a number of different measures of this kind of spending, but I think regardless of what measure you take, the message is still the same: a very high proportion of spending in Nova Scotia—either the highest, or near to be being the highest—is spent on health care, and at the risk of some other program spending.

Yet even with 39.3% of all program spending going toward health care, the per capita spending on health care in Nova Scotia is the second lowest in the country. Only P.E.I. spends less per capita. The average per capita spending on health in this country is a little over $2,000, at $2,016. Nova Scotia spends $1,835. So we have the highest proportion of program spending on health, yet we are only able to deliver a comparatively small level of per capita spending for each person in the province.

I think there are a number of things to bear in mind when looking at this situation. It is a reflection of a weak economy suffering contraction in traditional industries such as fishing, mining, and steel production, while facing the high debt burden this province must shoulder. With relatively few resources at its disposal, Nova Scotia must provide health care for a population with one of the lowest rates of health status, and consequently one of the highest needs for health services.

NSAHO asks that you consider a different model for the allocation of federal funds to provinces for health care.

Under the current federal policy, the CHST program transfers funding to the provinces on an equal per capita basis. The amount each province receives is determined by the size of its population. This approach does not consider the need for health services among populations.

To expand this discussion a little further, it's well accepted that older populations will place a heavier demand for services on the health system. According to Health Canada—this is from 1994—seniors over the age of 65, who comprise 12.7% of the population, consume 47.7% of all health services. Saskatchewan, which has the highest percentage of its population over the age of 65—14.5% of the population—receives the same federal funding per capita as Alberta, which has the lowest percentage of the population over the age of 65, at in and around 9.8%. The current funding model also does not take into account the strong economic base that Alberta has to fund its own programs.

There's a second example. This is why we have Mr. Kephart and Mr. Pennock with us. The Population Research Health Unit at Dalhousie University here in Halifax identified a substantial variance among provinces on a variety of health status measures. The same study identified a strong relationship between health status and utilization. The conclusion reached was that individuals with a low health status would utilize more health services—a fairly obviously conclusion, I think.

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If these higher levels of need among the provinces are met in a way that ensures the equity of access guaranteed by the Canada Health Act, then per capita health care use will be higher in those provinces with a lower health status.

The study estimates that per capita needs for Nova Scotia are as much as 10% to 15% higher than the national average; yet our per capita spending on health care in this province is much less than the national average, as I've just said. To maintain this modest level of spending, we must allocate 39.3% of all program spending towards health care, as I've already said. Therefore we feel that per capita funding is inequitable.

We're urging the federal government to collaborate with the provinces and the territories on the development of a needs-based resource allocation model that incorporates both the prevalence of conditions that generate demand for service and the need for investments to improve health of the population.

Our brief highlights a number of other issues, as I said, and in the discussion time we'd be pleased to elaborate on those if any member of the committee wishes. We wanted to use our time this morning to emphasize that now, more than ever, our Canadian health system requires a strong federal presence on policy issues that cross provincial and territorial borders, and it requires adequate funding distributed to the provinces on need, rather than a pure per capita approach.

One of the founding principles of the Canadian health system is that Canadians will have access to services based on need rather than the ability to pay. We believe this principle should also guide the federal government when it transfers the CHST funding to the provinces.

Thank you for the opportunity to speak to you this morning. As well, thank you for moving to this regional format as well. It has enabled organizations such as NSAHO to take part in our democratic process.

The Chair: Thank you very much, Mr. MacKinnon.

We'll now hear from the Independent Living Resource Centre, with Cecilia Carroll, chairperson, and Lois Miller, executive director.

Welcome.

Ms. Lois Miller (Executive Director, Metro Resource Centre for Independent Living): Thank you, Mr. Chairman and committee members, ladies and gentlemen.

My name is Lois Miller, and I'm executive director at the Metro Resource Centre for Independent Living here in Halifax. I'm filling in at some short notice for Mary Reid, my counterpart at the St. John's centre. Ms. Reid is out in British Columbia. We're all just back from a national conference there.

I'm here today with Cecilia Carroll. Ms. Carroll is chairperson of our sister centre in St. John's, the Independent Living Resource Centre of St. John's. Ms. Carroll is also the Newfoundland representative to our national association, the Canadian Association of Independent Living Centres.

Before Ms. Carroll outlines some of our recommendations, I'll just give you a little bit of information about independent living centres, who we are and what we do.

The independent living centre in St. John's, like my own centre here in Halifax, provides services designed by and for persons with disabilities. All of our independent living centres are managed by boards of directors elected by our members and “consumers”, as we call our persons with disabilities.

Our boards are consumer-controlled. They have a cross-disability focus—that is, they're made up of persons who represent a range of disabilities—and we are not-for-profit organizations.

We are members of the Canadian Association of Independent Living Centres, and that consists now of 24 centres, I think, across the country. We all promote independent living, which encourages choice and opportunities for persons with disabilities.

Independent living resource centres strive for the full inclusion of all citizens within our communities, the removal of barriers, and the end of discrimination that currently prevents people with disabilities from being fully involved in this country.

We firmly believe persons with disabilities must have full opportunity to take control of and take responsibility for the decisions that affect their own lives. Persons with disabilities are entitled to clear and accurate information, to the expertise of friends and neighbours, and to the support systems that enable full participation in our communities and our country.

Now I'll ask Ms. Carroll to continue with several specific recommendations for the committee.

Ms. Cecilia Carroll (Chairperson, Independent Living Resource Centre of St. John's): Thank you. I'd also like to thank you for the opportunity to speak here again this year.

The consumer and independent living movements have proven instrumental in the advancement of people who have disabilities. Continued federal support of independent living centres will result in the achievement of goals by citizens throughout the country who have disabilities. ILCs provide opportunities to be with peers, to learn, problem-solve, network, increase skills, secure employment, and access community and government resources.

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Our advocacy organizations as coordinated through the Council of Canadians with Disabilities ensure that our voices are present when policy is developed, justice is determined, and the public is informed. We recommend the continued financial core support of consumer and IL movements, as promoted through the consumer organizations of CCD and CAILC, with no reduction in the current level of funding to either organization.

Another point we'd like to talk about is home care and self-directed home care as well. The investment of significant dollars targeted for home care can equalize the playing field for people with disabilities. However, this will only occur if self-directed home support is recognized as a vital and essential service for citizens who require ongoing personal and home support due to disability-related needs.

The provision of home support to self-manage or self-direct provides not only a cost-efficient system of service delivery but is also a sensible and empowering approach to resource management. As individuals gain control over their lives, the economic and social spinoffs are tremendous. We recommend that we ensure federal home care initiatives include specific dollars targeted for self-directed, managed home support for persons with disabilities and commence discussions with community organizations to develop national standards for home support.

The last point we'd like to touch on is in regard to disability-related support. Canada has often been described as one of the best places in the world to live, and certainly we are ranked extremely high by many international grading systems. This cannot override the realities that many Canadians are routinely denied access to education, employment, health and community services solely because they have disabilities. Nor can it overshadow the fact that many Canadians are routinely locked away in institutions because their disability-related needs are viewed as too much for Canada to support.

This is most ironic in a country that prides itself on fairness and equity. The right thing for the Government of Canada to do is to allocate sufficient resources in the next federal budget towards coverage of disability-related costs. This would remove one of the greatest barriers to employment for persons with disabilities.

The coverage of disability-related supports will enable people to move towards a level playing field, to live in the community of their choice, to control their own lives, and to begin the process of moving in from the margin. We recommend that you allocate dollars within the next federal budget to commence work with consumer organizations towards the development of a pan-Canadian program to cover disability-related supports.

Thank you.

The Chair: Thank you very much, Ms. Carroll and Ms. Miller.

We'll now hear from the Newfoundland-Labrador Federation of Co-operatives, Mr. Glen Fitzpatrick, managing director. Welcome.

Mr. Glen Fitzpatrick (Managing Director, Newfoundland-Labrador Federation of Co-operatives): Thank you, Mr. Chairman.

The Newfoundland-Labrador Federation of Co-operatives is the provincial representative agency for the co-op business sector in the province. We've been around since 1949 in various forms. I haven't been around that long but have for a good bit of it. We are members of our national organization, the Canadian Co-operative Association, and I represent Newfoundland on the CCA's public policy committee.

On September 27 the Canadian Co-operative Association made a presentation to you in support of a partnership with the federal government to implement the national cooperative development partnerships proposal. This proposal will assist the federal government with its plans to assist Canadians to respond to opportunities in the new economy; initiate socio-economic development initiatives that will improve living standards and quality of life; and provide support services that will enhance the quality of opportunities for all citizens to succeed.

We are here this morning to add our support to this partnerships proposal and provide you with a provincial perspective as to its potential value in helping the federal government achieve its public policy priorities.

During this time of heightened fears and concerns about peace and security, many Canadians are reflecting on their values and what matters most in their daily lives. Often these thoughts focus on our families and the importance of community, which are the foundations for building a strong economy and social support network.

A strong sense of community and the values it represents have been the only thing that has held many rural communities in Newfoundland and Labrador together in recent years in the face of long-term economic difficulties, weakening infrastructure, and loss of public services. Recent statistics indicate that rural communities in our province continue to experience the highest unemployment rate, the lowest annual income, and the highest child poverty rate in the country. We want to see this change, and we believe new community economic development initiatives such as the national coop development partnerships proposal, and programs such as these, are needed to achieve this goal.

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We take this view based on our considerable experience in delivering CED services in rural communities. Since 1997 the Newfoundland-Labrador Federation of Co-ops has been delivering co-op and micro-business development support services for rural people in our province who are pursuing opportunities for self-employment. To date we have assisted close to 300 micro-business operators to achieve their entrepreneurial goals. The demand for these services is now such that we are proposing our program be expanded and delivered on a long-term basis.

Federal government agencies in our province have been most supportive of our efforts to date. However, as demand increases and new opportunities are identified we find it is becoming increasingly difficult to fit our many projects and services within federal funding programs, which often have very restrictive criteria and are designed to assist smaller scale initiatives on a short-term basis.

Implementation of a partnership between the Canadian Co-operative Association and the federal government would be an important step forward in helping us address this problem. It would also have a number of additional benefits in terms of our capacity to delivery co-op and micro-business development support services in rural communities.

It also will enable us to access more flexible long-term funding that will be the basis for negotiation of project-specific initiatives with ACOA, HRDC, the province, and other agencies.

It will also facilitate increased program efficiency, which will translate into improved client services as we are better able to focus on program delivery rather than being perpetually involved in short-term funding negotiations.

It will also enable us to develop new linkages with other co-op development and CED agencies across the country, and share information and expertise. There's a real sense of isolation in developing and delivering new and innovative community support services in rural Newfoundland and Labrador. There is much we can learn from other practitioners across the country and also much that we can share. The national co-op development partnerships proposal can be an important facilitator of this process.

The program delivery model we are putting forward is also most appropriate because although this would be a national initiative, there would be a real and immediate benefit at the community level. In this case, for example, administrative costs will be minimal for this program, as the CCA will use existing staff and its network of regional affiliates to facilitate service delivery. This will maximize funding available for projects at the community level, thereby increasing client benefit.

On a macro level, programs like the national co-op development partnerships proposal also help unite the country as we work in partnership with other development agencies in all provinces to improve the quality of life in our communities. We have a great deal in common but sometimes we don't know how much, and the CCA's proposal will not only help build communities, it will also help us learn about each other and from each other as we undertake new development projects within a national framework.

Mr. Chairman, this proposal is an important opportunity for us to significantly build our capacity to respond to the demand for micro-business and co-op development services in rural Newfoundland and Labrador. I thank your committee for your time and look forward to your support for our proposal.

Thank you.

The Chair: Thank you very much, Mr. Fitzpatrick.

We'll now hear from Ms. Jane Warren. Welcome.

Ms. Jane Warren (Individual Presentation): Thank you for the opportunity to speak, especially as I'm speaking as an individual. I'm also representing the Brain Injury Association of Nova Scotia.

This country lacks a system, an infrastructure, to provide, manage and monitor services for individuals with traumatic brain injury. The magnitude of the problems suffered by brain injury survivors is ignored by most of the provinces in this country.

Perhaps the difficulty is that brain injury is not recognized as a distinct disability because many factors can lead to a brain injury. It can result from a traumatic incident or it can be acquired as a result of another medical event such as a stroke, aneurysm, tumour, etc. Survivors of traumatic brain injury often have trouble remembering, concentrating, making decisions, and controlling impulses. They can also suffer serious motor, sensory, and emotional impairments that can change education and career goals and affect relationships with family and friends.

But not all traumatic brain injury-related disabilities are readily apparent to others. That's why TBI, traumatic brain injury, has been called the invisible epidemic. It's an invisible epidemic despite the large numbers of survivors in the Canadian population.

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The Ontario Brain Injury Association used 1996 census data to estimate the annual total number of traumatic brain injuries in Canada at 45,589, which is more people, in that one year, than the total number of Canadians killed in all of World War II.

As brain injury is a disability experienced by so many Canadians, it is vital that federal moneys be spent on treatment and rehabilitation of survivors. There is a need in Canada for clearly defined, continuous care for brain injury survivors and their families, ranging from acute care to case management to post-rehab services—that is, the care that is needed for as long as it is required. For many survivors, that will be the rest of their lives. Respite care for families and caregivers is also needed.

A clear federal definition of the continuum of care would expose gaps in each province's health care system. In some provinces, brain injury is not even classified as a separate disability. This lack of recognition relates in part to our system's inability to track the necessary data. Since so many other health conditions directly result from brain injury, it is difficult for the system to recognize the magnitude of the problem.

In Nova Scotia, for example, the brain injured are classified as and grouped with either the mentally ill or the mentally challenged. No appropriate rehabilitation is available under either of these categories for survivors, because treatments and medications for these classifications do not address the unique needs of survivors—their actions, behaviours, and abilities.

Brain injured survivors are faced with an inadequate system that forces them into health systems designed for other populations. As a result, they are warehoused in group homes for the mentally challenged, mental institutions, nursing homes, and often jails, with no appropriate rehabilitation.

A separate classification for brain injured people in Nova Scotia would contain about 2,200 new adult members per year and over 350 children, according to studies done in this province in 1999-2000. I don't know if similar studies have been done lately in other provinces.

There is no cure for brain injury, but with proper support a large number of survivors can become productive members of society again, thus lessening the burden on the social service system and the law enforcement, legal, and penal systems. This support and programs for behaviour, literacy, memory, and cognitive modification are limited in availability in all provinces.

This is where federal money could come into play. A database of the number of brain injured survivors could be obtained from questions on the federal census or from Statistics Canada. This data gathering would also help locate people who have sustained brain injuries in the past, lead to an assessment of their needs, and help in the provision of services to improve their quality of life. And how effective that can be. It has been shown that survivors can go from being institutionalized to being productive members of society. This does not happen very often because of lack of money for rehabilitation and constructive learning programs. Federal money could help here.

Data on traumatic brain injury can also be used to educate the population and policy-makers about brain injury, to develop and target prevention programs, to improve injury prevention legislation, and to deliver better services to survivors.

Hospitals could be required to report those who come in with actual or suspected brain injuries. It should be noted that many brain injuries go undiagnosed until long after the event that brought the people to our health care facilities in the first place. Medical schools should be required to devote more hours of class time to the study of traumatic and acquired brain injuries.

Federal money could help make visible the magnitude and scope of traumatic brain injury among Canadians with information to the general public and to the various levels of government. This information would enable governments at all levels to make the best use of resources to prevent brain injuries and to more effectively treat those that do occur. Legislation would require them to do so.

Survivors of brain injury receive less appropriate treatment for their disability than do other disabled groups. This contravenes the Charter of Rights and Freedoms, which is a federal responsibility.

Australia has federally recognized acquired brain injury as a disability, and the United States has had a bill dealing with traumatic brain injury since 1996.

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There are provincial brain injury associations in every province. As first movers in the area of brain injury survivor support, they are well placed to head a more formal movement—“formal” meaning stable federal funding. This funding would lead to a change in strategies for these associations. More energy and resources could be spent on education and prevention without having to worry about fundraisers to cover the basic costs of such things as photocopying, transportation, meeting announcements, etc.

Traumatic brain injury is a leading killer and disabler of Canadians under the age of 44. Because of its epidemic numbers, it should become a federal priority.

Thank you for your time and attention.

The Chair: Thank you very much, Ms. Warren.

We'll now proceed to the question and answer session. It's going to be a five-minute round for every member.

We'll begin with Mr. Jaffer.

Mr. Rahim Jaffer (Edmonton—Strathcona, Canadian Alliance): Thank you, Mr. Chairman.

Thanks to all of you for your presentations. I find some of the information very useful, and there were some things I wasn't aware of.

I have a general question, in light of all the presentations, because I feel they're all important and they're all raising areas of concern in various areas of health care or support. What I'd like is for whoever made the presentation to speak on behalf of the organization.

I think we have some big challenges ahead of us, given the events of September 11, especially when it comes to allocating resources. There's going to be a great demand in areas of security over the next little while, as well as the important areas you've all mentioned within your presentations. In doing so, in making those decisions, there's obviously been a great sacrifice made on behalf of Canadians over the course of the last number of years in trying to reduce the amount of deficit we've had in this country as well as the overall debt.

It seems to me we're making decisions for allocating resources in light of the new challenges as well as the fact that we have a downturn happening in the economy, and the surpluses that have been identified may in fact be less, or will continue to be eroded, over the course of this economic downturn.

I just want to get your overall feeling on whether the government should stay the course in continuing to keep Canada deficit-free and pay down the debt, as well as allocating certain resources that are needed in the areas of health care spending and other social spending, or whether it might be justified in this crucial time to take on deficits once again.

If I could have the opinion of the various panellists who made the presentations, I'd appreciate it.

The Chair: Mr. Fitzpatrick, Mr. MacKinnon, Ms. Miller.

Mr. Glen Fitzpatrick: I think from our perspective, given the issue we've just raised, what we're looking at here is a very targeted, very specific kind of initiative with a beginning and an end, and a product and a result that we expect to come from it in terms of the development of new cooperative businesses that are more in tune with the needs of the new economy and where Canada is heading in terms of its economic future and the growth we hope will continue.

I believe what's required here is a little more intelligent and targeted spending in terms of addressing specific problems in specific regions of the country. I think I identified one of them for you this morning.

Our organization likes the idea of what would be from our perspective a small program. We're talking about a $30 million program over five years. From a national perspective that would be considered small, I think. A national program such as what we have been proposing would provide these kinds of linkages and continuous support across the country in the targeted areas where they're most required.

If you look at the way the money we are looking for is proposed to be spent, it will use existing networks, existing organizations, and resources that are already in place to ensure the benefits that come from that $30 million end up in the rural communities we're trying to support and do not end up supporting a large bureaucracy of individuals working for a government department in St. John's, with a lot of the money going in that direction.

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So I think there needs to be some strategic thinking about how these things get done. More targeted programs would mean more intelligent spending of money, and public-private partnerships are the way to go with this. You want organizations like the co-op sector and other private sector groups and representative organizations to play a bigger role in terms of providing resource support but also in terms of the decision-making process and how those funds are expended.

Mr. Peter MacKinnon: On that point, perhaps there are a couple of issues at least. In an era of fiscal restraint and constraint and limited resources, our discussion around equitable distribution of resources is critical. It helps to ensure that the maximum benefit per dollar spent is there. So if you're targeting need and you're wanting to be sure that you get the biggest bang for the buck, our proposal around needs-based funding is the way to go.

The per capita approach, as we said, in some ways potentially puts money where it may not be needed as much. If we're trying to get the maximum benefit for every single dollar in a time of constraint and restraint, then needs-based funding we think is the appropriate approach.

The other point, which was the first one raised in our discussion today, was that spending on health and on health care is an investment. It's an investment both in terms of economic advantage, which is what I focused on in our presentation this morning, and in terms of productivity of people and of the nation. So if we're spending on health care both in terms of curing people when they'll ill and in promoting wellness and health, that will strengthen the economy, the productivity of people in the country, and it will help on the financial side for us as well.

So those are the two main points. There are others inherent in your question. Does health care cost too much? Are the costs galloping away on us? That's another discussion, but those two points at least we make.

The Chair: Ms. Miller.

Ms. Lois Miller: In response to Mr. Jaffer's question and his comments regarding deficit, that's one of the reasons we are here. Our organization—and I think Ms. Warren's as well—is concerned about the social deficit. We are concerned about the fact that many persons with disabilities, because of the current structure and the financial system in our country, are not able to make the contribution to our country, to their own communities, their families, that otherwise they would be able to make with appropriate support.

One of Ms. Carroll's comments had to do with the concept of disability support. My own organization made a presentation to the members of the legislature here in Nova Scotia. We were urging that disability support be separated from income support, but that, in fact, is not the case in Nova Scotia. In a number of provinces that is also not the case. Persons with disabilities are assumed to be unable to take their place in the community. So it's assumed that they'll all be living on welfare, in receipt of social assistance and so on.

We've been asking that adequate funds be in place for disability supports so that a person with a disability can move into the workforce, into the community, on what we call a level playing field.

As a little example, my own organization runs a small pilot project in self-managed attendant services in which people receive funding to hire and schedule their own attendants. We have nine people currently in that pilot project. Five of those people are not in the workforce for their own good reasons. They are parents, or whatever. Four of those people, who have a severe level of disability—all are quadriplegic—are currently working full time. We know they are able to be contributing members of the community because they have the adequate support they need.

So we are urging methods that would reduce the social deficit, Mr. Jaffer. I think that's the direction we're coming from.

The Chair: Anyone else?

Ms. Warren.

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Ms. Jane Warren: All the presentations have addressed at least two of the three objectives in your guidelines. They all want to create a socio-economic environment where Canadians can enjoy the best quality of life and standard of living. Some of them are pinpointing those who are disabled, some of them are pinpointing those who are in rural communities, and I am pinpointing the brain injured, but it goes for all Canadians. And it also provides Canadians with an equal opportunity to succeed. So if you don't have supports or the availability of services, you have less than an equal opportunity to succeed.

Lois spoke about the disabled on provincial social assistance. As of January 1, 2002, there will have been a 0.99% increase in the amount of money the disabled get in this province since 1981. That's 20 years and a 0.99% increase. And it's ridiculous to think that people are becoming more included in the community, more able to do things, if they have less and less money to do things with.

That then brings up the point that whatever-his-name brought up about the health care change in the funding, the health care dollars.

The Chair: Mr. Nystrom.

Mr. Lorne Nystrom (Regina—Qu'Appelle, NDP): Welcome to all the groups here this morning.

I'd like to start with health care.

Mr. MacKinnon, I like your idea about a needs-based funding formula. And we have some precedence for that as well, because we have an equalization formula enshrined in our Constitution that's based on a very complex set of indicators, province by province, to determine what each province should achieve under equalization.

In your opinion, why has this never happened in this country? The system we have today, on a per capita basis, you point out, is very unfair, because it doesn't take into account the varying sizes of the various economies. You mention Alberta-Saskatchewan, Alberta-New Brunswick. Alberta-Nova Scotia would be a good example, or Ontario. Why do you think this has never happened?

Mr. Peter MacKinnon: That's a big question.

Some of the reason for it is that if you look at a straight per capita funding, it's a simpler system. If you're willing to take numbers as the sole determinant of what an appropriate level is, then that makes it simpler to deal with. There's been some time in developing whether some of the arguments around what drives needs are really acceptable yardsticks for measuring needs. How do you actually hang some form of number on that? So it's more complex to do it that way.

We've seen a convergence around that approach in provinces, for instance. Various provinces do fund health care more on a needs basis than on a straight per capita formula. The methodologies for that do vary. It's a matter of getting past a certain amount of inertia and the fact that, frankly, some of the larger players with the larger populations perhaps have more clout. And to move forward on that, people first of all have to buy the needs-based funding approach, but they also have to understand that it is worth the effort and the work to put it in place and to have it implemented. Because, really, without doing it that way you place the provinces with a higher level of need...it's almost like ghettoization. You're in a certain spiral that is very hard to get out of.

In terms of looking at changing that need for service and that higher level of funding requirement, it requires an investment in the kinds of things that make populations more healthy. When you're stuck with spending 39%, 40%, or 40%-plus of your program spending budget on the cure side, on the acute care side of health care, that leaves very little to promote some of those things that some of the other panellists have talked about, in terms of creating healthier populations. It leaves the provinces sort of stuck in that dilemma.

• 0950

That's the part that needs to be sold. Maybe it hasn't been sold as well as it could have. Some of the counter-arguments we've heard against this is that by funding to the higher level of need, you're actually rewarding that behaviour or perpetuating that sort of need. We don't see it that way. We see it as having to go just in the opposite direction.

Mr. Lorne Nystrom: What do you think the appropriate role is for the federal government, in terms of funding of health care? In the beginning it was on a 50-50 cost-shared basis. A number of years ago there was a transfer of some federal tax points to the provinces, so now the cash transfer from the federal government to the provinces is very small. The provinces pay about 85% of the cash and the federal government about 15%. When you add tax points, it's maybe 30% or 35% from the federal government.

What is the appropriate breakdown? Should it be a fifty-fifty relationship or two-thirds and one-third? We're going through this big debate now in the country. The Romanow commission and other groups are looking at what the appropriate federal role is for health care.

The other question I have is more general, and for everybody. Where we've really fallen down in this country is in preventive medicine—nutrition, physical exercise, and making sure we have healthy people. Studies on obesity show we're getting to be a less fit, less healthy country. A number of years ago there was a saying around that a 60-year-old Swede from my father's homeland—my father emigrated from Sweden—was healthier than a 30-year-old North American. That still may be the case.

What are your recommendations on that side? On the other question I asked, about the appropriate level of funding, not that we could start it today, but we should work toward a goal. What should that goal be?

Mr. Peter MacKinnon: You're asking where to begin on that one. Well, I don't know; I guess that's the short answer.

It seems to me from where we sit the recent fiscal policy has disadvantaged provinces like this—the transfer of tax points and so on has not really benefited us. Whether we migrate back to a fifty-fifty cost share and go back to the old system, I'm not sure if that's the answer or not. I don't have the depth of economic understanding for that.

Whatever the pot is and however big we decide the pot should be, our argument around funding equity needs to be there. So whatever measure you take, you need to have that as an initial overlay. My colleagues may have further enlightenment on that. I'm sure they do, but I don't.

On the other part of your question around promoting health and that type of thing, some of the recent initiatives and discussions between the federal minister and the provincial premiers and ministers are on the right track. The role of the federal government is to set out the goals for the system, generally. Health care in Canada started out as a straight insurance program, as someone pointed out, to cover hospital and physician services. But we've moved well beyond that, and the provisions of the system really haven't kept up with that.

I know health is seen, in a lot of ways, as primarily a provincial responsibility, but I think there's a very big role for the federal government in setting the general goals for what the system should achieve. It may be setting better targets around population health status. We are making progress there, but we certainly can do better. It may be deciding which services shall be insured.

As we pointed out in our brief, there are some services that are not considered insured, and given the demographics of this country and this province, to make long-term care and so on not an insured service just doesn't seem to make sense. Home care is another one. I think setting the direction on those essential services is where the federal government should be headed.

The Chair: Mr. Fitzpatrick.

• 0955

Mr. Glen Fitzpatrick: I have a couple of points. As some of you may be aware, there are a number of health care cooperatives that operate in the country. The Regina health care clinic, for example, is one. They are set up primarily to look at the issue of preventative medicine and provide that kind of service.

We also have a number of home care co-ops and other types of cooperatives that are involved in the health care system. That model is not that well known here in Canada, but it is very well known in other parts of the world, particularly in Europe.

Again, just to get back to our proposal, we want to take some of that money to further explore some of those models, whether they are in health care, home care, or economic development, to see if those kinds of models can help address, in a substantive way, some of the issues around the increasing costs of health care, and how to get that stuff under control.

Particularly in rural communities, we're talking about a situation where we're getting people proactively involved in their own situations and their own well-being. This kind of cooperative model, where a health care co-op is owned and controlled by the people who access their services, is the very type of model that can give people back some sense of control of their community and their lives, and some ability to do some things that are going to make a difference for themselves.

I just wanted to make the point that the kind of work we're doing doesn't just focus on the economic development side. There are a number of social issues that the co-op model can also address.

The Chair: Thank you, Mr. Fitzpatrick.

Thank you, Mr. Nystrom.

Mr. Brison.

Mr. Scott Brison (Kings—Hants, PC/DR): Thank you, Mr. Chairman.

Thank you to all of you for your interventions. They're extremely valuable.

I have a concern about some of the demographic issues we will have to deal with in health care, not specifically this year or next year, but in 15 or 20 years. While we're grappling with current funding issues, there isn't really enough discussion on the long-term issue. That is sometimes referred to as a demographic time bomb, in terms of having an aging population when the eligible working population, or tax-paying population, is going to be sharply diminished. Atlantic Canada provinces, specifically Nova Scotia and Newfoundland, are going to be disproportionately affected by that, if you look at our demographics.

We're aware of this future trend. We know this is occurring, but there's sort of a vacuum of discussion on it. I guess it's because we're so concerned about some of the short-term funding issues. Mr. Nystrom mentioned the Romanow commission now, and there's also the Kirby Senate work on health care reform.

If you were in front of those individuals or groups today, what types of health care reforms would you propose that are not all on the funding side? This is a question fraught with political risk, but what do you see as the role of the volunteer sector? What do you see as the role of the private sector, in delivery in the future? Is it possible to have some private delivery but still maintain a single-payer system, for instance?

I'd be very interested in some of your insights on some of those issues. I think we need to have a frank discussion.

Ms. Cecilia Carroll: Just to comment on your question and the question before, we talk about putting more money into home-directed care. If you look at the cost, there was an article in the paper in Newfoundland the other day about a gentleman who had been discharged from hospital for almost a week, but was being kept in an ICU unit in the hospital because there was a freeze on home support and he was on a waiting list. The cost of keeping that gentleman in a hospital for a week, when he could have been home, far outweighed the cost of care in his own home.

• 1000

If you look at putting disabled people back into institutions—and you talk about the aging population—by the time you build all those institutions and staff them, you'll spend far more than you would by putting the money in now so the disabled people in this country can go out and contribute to the community by spending money, working, and volunteering. All our centres have a board of directors, our members are all volunteers, and they run very good programs, most of which are staffed by volunteers. Volunteers play a vital role in this community and this country.

Mr. Peter MacKinnon: On the demographic trend side, I would go back again to our equity argument. It has been demonstrated, again, that an older population puts a greater demand on health services. We do not have a completely uniform distribution of ages across the country or across any of the provinces, and I think whether we have to make the pot bigger to deal with that bulge is one question. I'm not sure what the real answer to that is, but in terms of distribution, again going back to our argument on needs-based and equitable funding, that would hold true as a response to that demographic shift.

In terms of the private sector involvement—I'll just try to touch on that for a minute—we have in our organization a number of private health service providers, mostly in long-term care. If you look at systems around the world, where there is perhaps a larger blend of public and private providers, there's no clear evidence that one is in fact better than the other. There are arguments on both sides of the ledger for who and what provide a better service.

Certainly, there's an important argument to be made that publicly funded and provided health care is in fact more efficient. The private sector operations that are in effect now tend to provide things that are very focused. I'm speaking of acute care services like hernia treatment, that are focused and planned and are more open to being run more efficiently.

On the public sector side there's a different goal, a different ethos, and a different operation whereby everybody who comes through the door gets served. The complex cases and the ones that are multifaceted and very difficult to deal with are thrown into the same mix as everything else. As a result, you have a fuller range of service provided, and there is a strong argument that it's provided at a very economical cost.

In terms of the federal role in moving forward on those things and dealing with the demographic changes, it comes back to setting the goals and deciding what sorts of things should be insured, about what sorts of programs need to be covered and considered as medically necessary and what we should do about the things that have been under debate, like home care and in some provinces long-term care. Those things are, again, medically necessary and should be part of the funding mix.

The other thing in promoting health is addressed in one of our other arguments. If you look at some of the trends that are apparent now and you straight-line them out based on the current burden of illness and how we expect an older population not to be as healthy as a younger population, minor changes in health promotion can provoke a dramatic shift in what the resource demand will be for a population as it ages.

If we are able to promote healthy living and get populations that are healthy well into later life, that will have a big impact on the cost and on that big issue we're going to face—namely, a smaller tax base to serve a much larger older population. Those are the kinds of things that come to mind.

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Ms. Lois Miller: If I could just make a comment in response to Mr. Brison's question—and I'm not sure if these are totally focused on your question—a couple of things come to mind.

In a province like Nova Scotia—and I guess this is along the lines of some of Mr. MacKinnon's comments—one of the demographic trends we've noticed is the high rate of disability in Nova Scotia. The most recent statistics I was reading, which are actually several years old now, showed that Nova Scotia had the highest rate of disability of all provinces. That is a very big factor in the cost of our health care. More than....

Ms. Warren is more up to date on that. It's over 22%, the highest rate across the country of persons with disabilities, and that's a very big factor.

Another factor is certainly poverty. Persons who are poor are more likely to be unhealthy. Nova Scotia and the other Atlantic provinces tend to have a higher rate of poverty. These are several factors we need to keep in mind.

You mentioned—I'm not sure if you used this word, but I will—the whole concept of partnerships, perhaps with sectors that are outside the public system. I can't comment so much on the—

Mr. Scott Brison: These are some of the sort of hybrids. I'm thinking of the VON as one—

Ms. Lois Miller: Right.

Mr. Scott Brison: —that sort of combines the two. I have a bias here because my sister is a VON nurse and supervisor, but that's the kind of—

Ms. Lois Miller: Okay. That's exactly the sort of system my organization, and to a lesser extent yours in St. John's.... We offer a self-managed attendant services program in partnership with Nova Scotia Home Care, and that draws on the expertise of the not-for-profit sector, the expertise of our volunteers, who are all themselves persons with disabilities and who can bring so much knowledge and experience to the effective operation of a program. We certainly do support those kinds of partnerships.

An evaluation of our program a couple of years ago showed that our self-managed attendant services program was 30% less costly than traditional models of long-term care. A similar program in Ontario, where instead of 10 people they had 100 in their test, showed in their pilot program a 30% to 50% cost saving with that approach. I think there are significant benefits from partnerships with the not-for-profit community.

The Chair: Thank you, Ms. Miller.

I'll now proceed to—

Mr. Glen Fitzpatrick: Can I make one comment?

The Chair: You sure can.

Mr. Glen Fitzpatrick: I think the basic issue, especially in health care and in the case of economic development as well, is to try to get the individuals who are accessing the services involved in the decision-making process in terms of what services they want, which ones they feel are priorities, and which ones they feel are not. Obviously, a small community with a relatively old population, say in rural Newfoundland, would likely have particular needs in terms of services they would like to see provided by the health care system in their particular region. The co-op model does provide for that kind of participation.

The other issue that really needs to be addressed here is the fact that we are not in any way getting the best we can from the volunteers who are involved in the system generally, not just in health care but in community economic development and in non-profit organizations generally.

To just give you an example, I know the health care boards in Newfoundland have just been asked to go through an exercise in downsizing their operations to deal with an overexpenditure in the budgets across the province. These volunteers—and they may be with school boards, with health care boards, or with our community economic development zone boards—spend a great deal of their time trying to deal with negative issues. How do we save money? How do we cut staff? How do we do it without impacting on services, etc.?

These volunteers, who are basically providing a free resource to the system, would be much better served if they used their time to talk about how we can better deliver services, how we can change things so we're improving effectiveness, and how we can respond to new issues that come up with respect to providing community health care. It's all very negative, and people get very frustrated. You don't get the best people coming forward to serve as volunteers on these committees any more.

• 1010

I can tell you, if the trend continues, we're going to see a real weakness in the system that nobody can predict right now, because it doesn't show itself on the surface. But if we end up in a situation where good people aren't coming forward because it's a negative process and it involves them in a frustrating exercise, you're going to see a real problem down the road in terms of how the system functions.

Those are two points I would make.

The Chair: Thank you very much.

Ms. Warren.

Ms. Jane Warren: According to GPI Atlantic, Nova Scotians contribute 134 million hours per year in unpaid voluntary work. That's worth $1.9 billion to the provincial economy. The entire volunteer sector across Canada accounts for one-eighth of Canada's GDP. So it's an important part.

There's vagueness in the legislation and written laws about it. IMPACS, from B.C., is doing a lot of work. They described that there are things you can or can't do, and those are not laid out. I think 10% of total resources in a charity or non-profit group can be devoted to advocacy. For a small group, you have to spending more time and energy to advocate for things, like brain injuries. For a larger group that has a $0.5 million or $1 million budget, 10% of their budget is a lot more than if you have only $20,000 to work with all year.

The Chair: Thank you, Ms. Warren and Mr. Brison.

We'll now proceed to Mr. Murphy.

Mr. Shawn Murphy (Hillsborough, Lib.): Thank you very much, Mr. Chairman.

First of all, I want to thank you very much for the excellent presentations. Since most of them dealt with the whole health care issue, I want to direct my first question to you, Mr. MacKinnon, and perhaps invite the other members of the Dalhousie unit to comment. It's about the whole issue of best practices.

I think we're having a major national debate on health care, and I assume you'll be appearing before the Romanow commission and the Kirby commission.

There's one thing we all agree on, that there's not enough money in the system. You people see that every day. But I want to get your comment on the whole issue of best practices, and specifically best practices in Atlantic Canada.

By the way, I come from Prince Edward Island. I'm aware of the problems in Nova Scotia, and as your report indicates, there are similar problems in Prince Edward Island.

I'm not a health care professional. I don't know a whole lot about the system, but as a parliamentarian, we do spend an inordinate amount of time on health care issues.

But it appears to me—and I can only speak for Prince Edward Island, not for Nova Scotia—that the whole issue of best practices is perhaps something that is not being pursued enough. Technology in today's society is a great equalizer, and it appears to me from the outside, looking in, that politics gets in the way of a lot of best practices implementation.

By that I mean politics in the medical profession, the physicians being the gatekeepers of the system. They don't always embrace change immediately.

Are you going to hit me?

Ms. Carolyn Bennett (St. Paul's, Lib.): No, but you could say it stronger.

Mr. Shawn Murphy: My colleague here is a physician.

Secondly, in the smaller provinces, we have the party politics, and there's no greater vote-getter than to promise a community a new hospital or that you'll never close a hospital bed, which might not be the best decision in the long run for the utilization of scarce resources.

So there's a lot going on with cooperative practise, the whole use of technology, and technology in patient records. We've had a number of other groups and organizations, mainly from Toronto, make presentations. So I'd like your comments.

Are you people satisfied that the provinces within Atlantic Canada are utilizing the best practices? If not, what more can be done?

Mr. Peter MacKinnon: I'll start off, because we did address this question a little bit in our brief, not so much in our presentation.

One thing, to echo what you've probably already heard from CHA and maybe in some other settings, is that determining what the best practices are requires measurement, and measurement requires information systems. There already have been some federal moves on creating a stronger information systems infrastructure in the country. We hope that role continues and strengthens, and we hope that translates out at a provincial level.

• 1015

For us, that's one of the first things. In order to know what it is, you have to be able to measure it, and information systems are a big part of that.

The other big part that goes along with that, of course, is conducting the basic research around what the best practice is. Maybe our colleagues from the university can speak a little more eloquently to that.

In terms of the politics getting in the way of implementation, it's interesting; I was at a session last Thursday and Friday in P.E.I., and Jamie Ballem, the Minister of Health, who spoke at that gathering, had some of the same observations and comments. He didn't have the crystal ball to figure out what the answer is on how to get around that.

For me, though, a lot of it comes back to the proper information and marketing that information once you've decided or figured out what the best practice is. That's something we've not done well. That's part of the reason we looked at this as an opportunity to have both George Kephart and Mike Pennock here with us today, as researchers partnering with a pair of administrators, because I think that's part of what happens; the information that gets pulled together on the research side in the defining of best practice never gets to a policy level. A lot of that is because there is a certain level of disconnect between the research community and the policy-level community.

So we're looking into some of the new initiatives through.... I don't know if it's CHST; I can't remember the exact name of the grant-funding agency.

Mr. Shawn Murphy: It's CIHI.

Mr. Peter MacKinnon: CIHI and others are focusing on making that link.

That sort of work and the support the federal government has been providing to that will be critical in moving that other agenda forward, first to define the best practice and then also to implement it and be able to overcome the politics or whatever other impediments there are to getting the best practice.

Mr. George Kephart (Director, Population Health Research Unit): I think you've really hit on the big challenge. A number of questions here have addressed what share of total health care expenditures the federal government should pick up. The bottom line in all this is that health care expenditures are growing like crazy. They've been growing, on average, about 7% to 10% per year for quite some time. They've had their ups and downs, but they continue to grow.

I think it's fair to say, with increases in technology and in the kind of things we can do, with approximately 300 new drug products a year entering the market, health care expenditures are prepared to eat up every dollar we're willing to throw at them. We will always have scarce dollars for health. That's inevitable. The question is, how do we adapt to that? How do we ensure that we provide good health care for our citizens in that situation?

Ultimately, then, it all really boils down to how to get the best bang for our buck. How do we promote efficient use of the limited resources? This will always be the challenge.

There are several dimensions of this. One of them has to do with how dollars are distributed, which is really what NSAHO has focused on and our report addresses. But that's only part of the picture. Simply throwing more dollars is not necessarily going to solve problems. We have to figure out how to spend those dollars more efficiently.

It's ludicrous, perhaps, that while we're prepared to spend huge sums of money in our insured system on caring for the patient who experiences long-term disability as a result of a stroke, we're not willing to pay for the basic blood pressure medication that may help prevent that stroke in the first place. That doesn't make good sense. That's not an efficient use of resources.

Funding constraints are a key barrier to implementing best practice. I think Nova Scotia perhaps provides a good example. Whereas Nova Scotia, which is still facing deficits and has a huge debt, continues to face the fiscal challenges of paying for its health care system, it has now several times shelved key investments in health information systems because it can't afford them.

At the fringes of the system—in other words, the things not covered under medicare—is where you'll see some of the worst efficiencies in the poorer provinces.

• 1020

If you talk to parents in Nova Scotia who have a child with a disability, they will tell you there are far fewer resources in Nova Scotia. I spoke recently with parents who have a child with autism and who had lived in Ontario. They pointed out that the child in Ontario has tremendous resources, whereas in Nova Scotia a child has few. A parent who needs access to an occupational therapist for their child can get fairly ready access in Ontario, whereas at the children's hospital in Nova Scotia right now there's a one-year wait for an assessment for an occupational therapist.

The things that fall at the fringes of medicare—that's where we see the real cutbacks in the poorer provinces, which are facing the biggest fiscal difficulties in paying for health care. I think this really comes out in the presentations by the other groups here.

We have to make a key investment in Canada in promoting more efficient uses of the resources that we have. What information do physicians, faced with 300 new drug products a year, have at their disposal to decide what they should prescribe? The main piece of information they have is sales representatives from the pharmaceutical industry, who come in and provide them with suggestions about what they might want to prescribe, and who provide the evidence. Our provincial governments are often doing a fairly poor job on that.

That's just one example, but there are many. I think it's not so much knowing what the best practices are but also communicating those best practices effectively to providers in institutions.

Mr. Shawn Murphy: I have just one quick supplementary. I know I'm over time.

Do you feel from your own research and your own experience that in Atlantic Canada we're lagging behind in best practices?

Mr. George Kephart: I think it depends where you address that question. In some areas yes and in other areas no.

One of the advantages in a small province is that it is actually politically much easier to be innovative. For example, in Nova Scotia right now we've assembled a group known as the Drug Evaluation Alliance of Nova Scotia, which is routinely cited federally as a best practice. This group brings together academics and people who are involved in continuing professional education around addressing critical drug care issues in the province to try to intervene to promote best practices.

That kind of thing is much easier to do in smaller provinces, simply because you can get all the players together. I would suggest to you that small provinces offer one of the most fantastic laboratory opportunities around right now for trying to develop best practices. It's far easier politically to do some of these things in Nova Scotia or Prince Edward Island or Newfoundland or New Brunswick. In smaller provinces it's easy to do this because you can get all the players face-to-face.

The Chair: Thank you very much, Mr. Murphy.

Dr. Bennett.

Ms. Carolyn Bennett: I'm interested in the needs-based way. But when you look at your background document in terms of the NHS, I worry that a province with an aging population versus a province that has more.... For example, 50% of the aboriginal population is under 25, but they may actually have greater needs. When you even look at what the NHS has tried to do, I worry that it is yet another fight about money in terms of who deserves more.

As well, as you say, with regard to the perverse incentive in rewarding bad behaviour, does that mean you don't put in the prevention programs because you get more money if you have too many bad health outcomes?

I want to know, how do we move to a proper incentive system in both health outcomes and health service delivery outcomes? Would you see that we could reward provinces that have interesting, innovative things that have been shown to work? And we give them a prize—whether that's Victoria's self-help manual or the nurse...such that you watch the inappropriate use of emergency departments and family docs go down, or whether it's the Nova Scotia Drug Evaluation Alliance, or whatever. Then you give them some money to go and do another innovative, neat thing.

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But part of that is the speaking tour across the country. If you've developed something that's been shown to be a best practice, as Shawn Murphy has said, then you get rewarded for that. If we give cognitive therapy to the brain injury people, we actually have those people back working, paying taxes. That seems like a good outcome. How do we develop...?

Maybe this is with CIHR and population health. How do we use all of the money we're spending federally to incent good behaviour and, as you say, operationalize what we now know works but are having terrible trouble implementing? If you get more money to implement it, wouldn't that start to align the various players to do good stuff, rather than just do it on needs?

Mr. Peter MacKinnon: All of those are good ideas. All of those things taken together make sense. One thing we discussed in our written brief had to do with how we get from where we are to where we want to be—the whole issue of some transitional or parallel investment in going from the system we have to one that rewards those kinds of outcomes, promotes those kinds of outcomes, and has a healthier population at its base. There has been some federal direction on that. The primary care transition fund has been promoted. There has been—we were talking before we came in—a serious investment in research around outcomes and linking research to policy, which I think is an important step in getting from where we are to where we want to be on the outcome side.

Those kinds of moves and incentives need to stay there. We would support doing it in a very deliberate way and continuing with some of the programs that have already started in a small way. I mean, $850 million around primary health reform sounds like a fair number, but when you break it all down over X number of years to every province in the country, it is a small amount to work with. But it is something to work with.

So those are the types of things. There has been a lot of work done on what should get paid—down to the physician level—to try to incent those kinds of outcomes and to have physicians engaged in things that promote health. If that policy direction is provided at a federal level, that will translate into a provincial level, because where you decide to put your money is where the activity will occur. People will chase wherever the money is placed. If we invest more in building acute care beds or have them there, the old axiom that a built bed is a filled bed will always hold. Without stepping back and being any more analytical about it, those are the kinds of things that would come to mind for us—for me, anyway.

Ms. Carolyn Bennett: I had a question for Jane.

Are you sure that the new health limitations survey will deal with your issue?

Ms. Jane Warren: No.

Ms. Carolyn Bennett: As you know, they went around consulting, making sure that the questions will be in the new post-census survey. Do you feel that your issue will be dealt with there?

Ms. Jane Warren: No, I'm sure it's not going to be. I can't say particularly why.

Ms. Carolyn Bennett: Have you written to Statistics Canada and made sure?

Ms. Jane Warren: Yes. And I was a consultant for one of the censuses.

Ms. Carolyn Bennett: Will you send me those letters? I chair the subcommittee on persons with disabilities. We will make sure they understand that they want.... We'll see if we can get the questions. It's way too far along the process.

Ms. Jane Warren: I sent a letter to Wendy Lill. She said she was going to send it on to your committee.

Ms. Carolyn Bennett: Great.

Ms. Jane Warren: But my comment was that best practices are not transferable. Just because you have a best practice up here, it doesn't mean that the provinces are going to use it because—and I'm speaking solely from the aspect of being disabled on social assistance—you get a pharmacare card, or whatever it's called now, to pay for your prescribed drugs from a physician.

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Well, the number of prescribed drugs is lessening in number. I was talking to one lady with, I think, cerebral palsy. She said she's been on one drug for years. It was covered by the pharmacare card, because it was covered by MSI. She says it isn't now, however, and has to try something new, to change over. And the new drugs, the ones the doctor tells you don't have as many side effects, are not covered for years. So you have to convince the provinces that this is the best practice, or that the new drugs are better, because you can't afford them if you're on social assistance.

Ms. Carolyn Bennett: I totally agree.

One of the things that's been very interesting to me and that I hope Mr. Romanow will look at is Peter Singer's work on the accountability for reasonableness, which is this new ability to have extremely transparent ways, and involving the citizens, of deciding how health decision fundings get made, why a drug is covered or not covered, or why you would not pay for long-term care.

I think it's reported in this week's British Medical Journal, but Peter Singer and the University of Toronto Centre for Bioethics spoke at the CMA meeting in Quebec City this summer. I just hope the whole country would demand that there be this accountability for reasonableness in how health care dollars are being spent, because the minute the public starts being aware how these decisions get made, they get to have a say—an appeal, an enforcement power, even—in these decisions, because they get it: this is why we decided to pay for this instead of that. As you've said eloquently, there's always going to be a trade-off.

I for one am not saying.... The aging population doesn't scare me at all, as long as we can all stay well. Most of the costs are during the last two years of your life, regardless of how old you are. I'm not worried about escalating costs in drugs if it keeps me out of the hospital, because that's really expensive.

But we have to do a “big picture” thing. Concerning the big picture, I was wondering if our friends from the Independent Living Centre had seen the CACL presentation to the finance committee concerning a joint federal-provincial approach to supports and services, or whether you would have a look at it and let us know at the committee what you think. I think it's following in unison from your brief. It's a way of dealing with this big difficulty, that income is sort of federal but sometimes provincial, while supports and services are provincial. It offers a joint way of going about it.

Ms. Cecilia Carroll: Just to make a comment too on what Jane said, personally I have for different reasons gone to the doctor, and he prescribed drugs. They always prescribe the expensive ones, and the drug plans cover them.

Now, there was one instance for me where I tried four different drugs, and the cheapest one was actually better than all the expensive ones, but the cheaper one is not covered under the health plan.

So there is an example. You can spend $100 a month for a prescription or you can spend $17.50. Now, obviously a person who doesn't have a lot of income is going to go for the expensive one, because they don't have the $17.50 to pay for the cheap one, which actually works much better.

Ms. Carolyn Bennett: [Inaudible—Editor]...Health Canada would be stockpiling the most expensive drug to treat anthrax, myself, when there are about five other really cheap drugs that would do it.

A voice: The generic preference—

Ms. Carolyn Bennett: Generic, Cipro—I don't care; Cipro is not the drug we would be using. Even as Health Canada is buying the most expensive drug for a certain treatment, how can we expect people to take penicillin for strep throat?

Anyway, it's just a small problem I'm having this week.

Voices: Oh, oh!

Ms. Carolyn Bennett: I'm tired of seeing Cipro on the front page of the newspaper every day, because it's an extraordinarily bad example. So I promise I will take it outside.

The Chair: Have you got some herbal tea, camomile? It's not that expensive, actually, and it works.

• 1035

I've been in elected office now since 1988, and the health care file has always been one we have a lot to deal with. This panel is a perfect example of the wealth of knowledge and insight and expertise that exists in this country, yet it's always the same issues that get repeated for over a decade now.

We talk about funding, about effective partnerships, leveraging, outside expertise, best practices, flexibility, innovation, thinking outside the box—all these terms—and I tell you, as a guy who has spent most of his political career consulting Canadians, I'm often puzzled how a decade can go by and I'm still hearing the same voices and the same issues, and we're not any further ahead at the end of the day.

If it were that easy, Canadians would just throw out governments and replace them with good ones. Or are they all equally poor? I'm not sure.

The point I'm making is that usually when a nation decides to take on a major challenge, the sense of urgency comes from the people. On the health care issue, I'm not saying progress has not been made, but I will say, based on this presentation and many others I've listened to over the years, there's a lot of room for improvement.

Now, help me out. Why is it that a member of Parliament like me, 13 years later, is still listening to the same things? What are the obstacles we must overcome to get to the truth—if we can use that word when it comes to health care—without being partisan here? We have challenges in every province, including Saskatchewan and British Columbia and Ontario and others. But I don't think this is an issue that really requires political posturing, because we're dealing with people's lives, with children's health, with issues that require an approach that speaks to a higher value.

I just want you to help me out here. Why is it we're still where we are?

Mr. Glen Fitzpatrick: Speaking for myself—and again, this applies not only to health care but also perhaps to education, perhaps to economic development—we really have to present the public with some new models, to be proactive and bring the models to them, as opposed to always expecting the organizations that lack resources, or have needs, to keep presenting those needs to you and come up with the alternative that's going to work for them. I think you need to bring something back to them that gives them some hope, that gives them an opportunity to fit themselves into a new model that may work better than the status quo.

I think you need to challenge people on a community level to participate in those initiatives or be left behind. From that perspective, if you look at rural communities in Newfoundland and present them.... People are all thinking the same way here. They're all thinking about what they're going to lose: we're going to lose our hospital, our clinic, our doctor. That's all a negative kind of view about what bad things are going to happen if we vary even in the slightest from the status quo.

But if you go back to these people and say “How be it we look at a new way of doing business that involves you every step of the way, that helps you participate in the decision-making process, that helps you decide for yourselves in your region which health care services are a priority for you?”, then I think you'll get a buy-in from the public to that kind of process.

I guess I'm looking at this as a very community level type of thing. I think the kinds of pilot projects you're talking about and the kinds of rewards you're talking about make a lot of sense at the community level. From those initiatives, you will get the examples that I think you can take elsewhere and say, this worked in a rural region of Newfoundland, so perhaps it can work in a rural region of B.C., or wherever else.

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I really think there needs to be more work done on what fundamental alternatives there are to the status quo that we can look at, and the co-op example is one of them. I really think you should look at groups like the Regina health care clinic and see what they're doing that makes economic sense.

The Chair: Let me ask you another question.

The comments we hear about health care in hearings like these tend to be...I won't say “negative”, but they tend to outline the flaws of our health care system. Do we spend much time assessing what is in fact working in our health care system? I don't want to leave here with the impression that the only thing we can say about our system is that it's flawed, because people still get treated in this country. People still have access to health care. When you compare it with many, many other countries, this system isn't exactly the worst system in the world.

When do individuals like you not only criticize the system but also give us at least a certain sense that you're happy with the base of services or accessibility? Above and beyond pointing out what is flawed—that's important for us to know, because we're here to fix problems—when do you say to Canadians, these things are going extremely well, but this is where there's room for improvement? Do you have a responsibility in the role you play in your community?

Mr. Peter MacKinnon: One of the things that plays a big role in NSAHO and all the member organizations is that not quite all but most of the organizations have volunteer boards that govern their operations. One of the main things those boards are responsible for is accountability to the publics they represent. It's through that kind of accountability, reporting on how the system is doing and how the organization is doing, that you have the opportunity to say what is going right.

That's why in our opening remarks we wanted to say that as a system and as a country our health status indicators are reasonable. In comparison to OECD countries, we are up there.

To get back to your earlier question, you said we've been hearing the same things for 13 years, and you can go back to the Hall commission and the Lalonde commission, 20 or 30 years, and the message has been the same, that we need to try to improve the efficiency, stretch the money we have and put it to its best use. We also have to begin to create healthier populations. Really, those things need to run on almost parallel tracks, as we said earlier.

To create the healthier population there needs to be an investment, and in some ways to make it a more efficient system, you need to divest of some things. I think that's part of the complexity and part of the reason we're still here 20 years later with the same issues on the table. The investment side takes a long time to pay off. It takes a generation for some health promotion things to really have an impact on the status of the population. So I think that is some of the reason we are less often talking about the gains, the benefits, and the good things about the system.

One of the things we were able to say with a lot of confidence up until the last couple of years was that once people were in the system, there was a very high level of satisfaction. We're still able to say that to a certain degree, but we're seeing a lot of dissatisfaction, on a public opinion basis at least, with access, and in some cases, although a lot fewer, with the care provided within the system.

So we do have that responsibility very much throughout the system, to report on the things that are good, and most health organizations in the country are trying to report on various dimensions that will say to the public, these are the things we do well, and these are the things we could improve.

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The Chair: Just to make a final comment, I think an issue that is true not only of health care but applies to a number of issues across the board is the issue of individual responsibility. We've talked about hospitals, community organizations, government funding, everything. The only person we forgot, ironically enough, is the individual Canadian. The individual Canadian also has a responsibility to take care of himself or herself. We don't have to wait for Romanow or Kirby to tell us there are certain eating habits and ways of taking care of yourself—in the sense of prevention—that can benefit the entire country by reducing expenses, not to mention make for a healthier lifestyle.

When does individual responsibility enter the public debate on health care? Why do we always talk about...? Why do we “institutionalize” the debate? When does the individual begin to be part of it?

Mr. Mike Pennock (Research Director, Population Health Research Unit): I think it's always been there. It's been part of it for 30 years, so I'm not sure I would agree with you. It hasn't been part of it at this table, necessarily, but certainly the whole emphasis on health promotion and lifestyle, including ParticipAction.... In fact, Canada's led the world in promoting that way of thinking about health.

The Chair: Is ParticipAction still on?

Mr. Mike Pennock: I'm not sure. But starting with the Lalonde report, Canada has been seen as a world leader in promoting lifestyle factors in health. So I think it has always been there, and I would disagree with you that it hasn't been. Individual behaviour and all those aspects of health promotion have always been a core part of the discussion on the health of Canadians, even more so than in other countries.

I think where it gets difficult is when you ask how that translates into health care policy. Where it gets difficult is when we start saying if somebody's overweight and hasn't looked after themselves, does that mean we should respond to them differently in the health care system? That's not an approach I'd support, and I don't think most Canadians would support it. If you look at, for example, the national population health survey and start pulling out all the health behaviours that have negative health consequences, there are very few Canadians who don't indulge in at least one of those.

So when do you start saying that obesity is better or worse than smoking? You'd rule out a great number of the population if you started saying we're going to respond from the health care system differently to people based on their individual behaviour.

I think all the discussion of the role in individual behaviour and health care has been around health promotion. We've made great strides. Look at the reduction of smoking in the Canadian population as a result of that.

Where we get reluctant is when we try to merge that into the health care system and start saying that, somehow, health care should respond differently to individuals based on their individual behaviours. I don't think as a nation we've really been willing to take that route, therefore we don't really even want to talk about it that much. Morally and ethically, it doesn't seem to be a road we want to go down.

The Chair: I'm part of that generation that grew up with the famous ad about the Swede being a lot healthier than the Canadian, and it left an impact on me, for example, and I'm sure many others. What I'm saying is those public statements and public education can really be helpful.

Mr. Mike Pennock: Oh, absolutely, and I'm arguing it has been very helpful for the last 30 years, since the Lalonde report. It's had a major impact on the health status of our population.

The Chair: Then you're happy with the present health care system, essentially, at least on that front?

Mr. Mike Pennock: Yes.

The Chair: Okay.

Mr. Mike Pennock: Well, happy.... It's not really a matter of being happy.

The Chair: Are you satisfied?

Mr. Mike Pennock: It's a question of whether it's been having effects. Yes, it has, and the direction is generally very positive.

The Chair: Okay.

Ms. Warren.

Ms. Jane Warren: I'm speaking from a social assistance point of view right now. If you don't have the money in your pocket to buy two litres of milk, which is $2.80 for two litres, and you have only $1.09, you're going to go out and buy two litres of pop, which is not healthy, rather than two litres of milk. And there's nothing you can do about it.

• 1050

So the social assistance program in this province breaks most all of the federal determinants of health. I could go through each of them. There's no way you can care for your health if you don't have money in your pocket or if you're not able to go access a service. As you say, two litres of pop is not healthy, but during the last week of the month, or the last two weeks of the month, you have to make a choice between buying milk or Tampax. And you pay tax on both of them, which I don't really think should be done. You don't have any choice.

ParticipAction is no more, so we didn't have any money for that, did we?

The Chair: Yes.

We've touched on a lot of issues today. I want to thank you very much. This has been very interesting.

Just so that you're not left with the wrong impression, for 13 years, I haven't heard all; you've brought up more material for me, and the committee, to think about. It's not all repetition. But I hope you got my message, and we're as committed as you are to bringing about the types of positive change required in this area, because there's nothing more important than the health care of Canadians. For your input, we're very grateful.

We're going to take a break before we go to our next panel.

• 1051

• 1105

The Chair: I'd like to call the meeting to order and welcome everyone here this morning.

This is our second panel of the day in Halifax. It is a pleasure to have with us, from Child Care Connections Nova Scotia, Elaine Ferguson, executive director; from the Nova Scotia School Boards Association, Mary Jess MacDonald, first vice-president, and Lavinia Parrish-Zwicker, president; from the MacKillop Centre for Social Justice the director, Mary Boyd; from the Annapolis Valley-Hants Community Action Program for Children, Pauline Raven, regional coordinator; and from the Nova Scotia New Democratic Party the finance critic, Mr. Graham Steele.

We usually give five to seven minutes for your introductory remarks, then we proceed to a question and answer session. It's important to keep within that timeframe, because the members of the committee really like to ask questions, and I'm sure you like to give answers as well.

We'll follow the order as set out in the agenda, so we'll begin with Elaine Ferguson, executive director of Child Care Connections Nova Scotia. Welcome.

Ms. Elaine Ferguson (Executive Director, Child Care Connections Nova Scotia): Thank you.

We're a non-profit community-based development organization for the child care sector. I'm pleased to be here to present you with recommendations regarding budget priorities from the child care sector.

The child care sector in Nova Scotia commends the federal government for providing leadership and developing and committing funding to implement an early childhood development strategy in the provinces and territories. It is gratifying that our federal, provincial, and territorial governments have recognized that as a society we have an obligation to our young children to provide them with the best environment, so that they can reach their fullest potential. This recognition is an important first step in maximizing the potential of Canada's young children.

There is a Yiddish proverb: “If I am not for me, then who will be? If I am only for me, what will be?” Please take my remarks within the former context. I am speaking from a child care perspective. However, as I am a person who has committed 30-plus years to children and those who care for and about children, please know that my remarks are not meant to exclude other early childhood development services. I fully recognize that I cannot be for child care only, because of the “what could be” consequence of such an approach. As I work with the Nova Scotia child care sector, I have found that child care practitioners in Nova Scotia support this approach.

In the realization of a quality early childhood development system, as articulated in the early childhood development agreement, it is vital that it has a quality child care system as its cornerstone. The cornerstone of a comprehensive early childhood development system is a quality child care delivery system. Quality child care focuses on the needs of children as a group. It individualizes the program to address the broad range of needs presented by children and families using the service. The users are from all aspects of a community; they represent a diverse range of ability, financial standing, religious orientation, cultures, etc. Child care is a meeting place for any family. It provides services that can be utilized by all children. It provides programs that enhance any child's early years growth. Other early childhood development and parenting services utilize child care to supplement their specialized services, such as those they offer to children with individualized special needs.

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Enhancing and expanding the existing child care system will provide a strong vehicle for effectively strengthening and extending all early childhood development and parenting services.

The following recommendations draw on the principles, priorities, and components of the early childhood development agreement, applying them to a child care system as a cornerstone of an effective early childhood system.

First, to realize two of the priorities for action in the agreement, strengthening early childhood development learning and care and strengthening community supports, we recommend that the federal government, in cooperation with the provinces and territories, commit itself to an early childhood strategy with a quality child care system as its cornerstone. That strategy would include clear implementation plans, with targets and timelines for the development of child care and related services. It would include a national, affordable, accessible, comprehensive child care system that provides quality child care above minimum licensing standards.

Second, to effectively realize the objectives and priorities for action through the commitment of a long-term, incremental, predictable, and sustainable funding system, it is recommended that the federal government increase its contributions through the early childhood development agreement. Two billion dollars over five years is not enough. For example, our Nova Scotia government has committed $6 million per year for the next five years to stabilizing the child care delivery system. If all this money were used to supplement the appalling wages of child care practitioners, it would mean that $21,400 would be the average wage of a child care practitioner in Nova Scotia.

This one-time increase will not do much to address our retention and recruitment crisis. There is much more to do here in Nova Scotia to ensure a quality child care delivery system. The sign-on of “Canada's Kids Campaign” recommends that early childhood development funding be increased, with $2 billion in the upcoming year and an escalating commitment in each of the following years for the enhancement and expansion of child care and related services across Canada. This recommendation is supported by members of Parliament Wendy Lill, Alexa McDonough, and Peter Stoffer from Nova Scotia. As well, it is supported by members of Parliament from other provinces and territories, including the Liberal members Andy Savoy, Andy Scott, John Godfrey, Lynn Myers, Dennis Mills, Bryon Wilfert, and Ron Duhamel.

Third, in recognition of the knowledge and information and effective practices component of the agreement, which recognizes that research, knowledge, and information are critical in informing policy development, it is recommended that the federal government commit itself to research and development funding programs, such as the former “Child Care Visions” program of HRDC, that will contribute to the continual improvement of the quality of child care services and the realization of the vision articulated in the agreement.

These recommendations are some of the necessary next steps to be taken in realizing a national comprehensive early childhood development strategy. I challenge our federal government to utilize the success of the acceptance of the early childhood development agreement among the provinces and territories by taking this next step and instituting a national child care system and dedicating funding to it.

Thank you.

The Chair: Thank you very much, Ms. Ferguson.

We will now hear from the Nova Scotia School Boards Association, Lavinia Parrish-Zwicker.

Ms. Lavinia Parrish-Zwicker (President, Nova Scotia School Boards Association): First, I would like to thank you for giving us the opportunity to speak to you. And I do apologize, but we have a board members workshop that starts at 12:30, so with your permission, if we're not finished, I will be leaving at 12, so that I can open that session.

I am Lavinia Parrish-Zwicker, the president of the Nova Scotia School Boards Association, and I am an elected board member from the Annapolis Valley Regional School Board. I have with me this morning Mary Jess MacDonald, who is the first vice-president of the Nova Scotia School Boards Association, and she is an elected board member from the Strait Regional School Board.

The Nova Scotia School Boards Association was founded in 1954, and it is a non-profit organization. It is dedicated to excellence in public education. The association provides leadership and services to the eight elected school boards around the province, which serve more than 158,000 students. NSSBA is funded by its member boards, and it promotes their objectives through advocacy, partnerships with other agencies, and cost-saving measures.

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NSSBA has had the opportunity to be at this table before for presentations in 1998 and 1999, and we highlighted such things as child poverty, federal-provincial-municipal infrastructure programs, technology, and second-language issues.

Today, in regard to a number of the recommendations that NSSBA built on, and the commitments and programs started by the federal government, we are going to cite a number of things in our presentation from the throne speech of 2001. We also want to compliment the federal government for a number of the steps they have taken towards addressing children's issues in Canada.

NSSBA does feel that the federal government must recognize that Canada can't be a player in the global economy without providing the social infrastructure to ensure that all Canadians have the chance to realize their full potential. What I have done in our presentation for the provincial association is address the three goals of the committee's pre-budget report as set out in a letter that was sent on June 20, 2001. To expedite things, I will highlight the recommendations under those.

The first one was to create a social and economic environment where Canadians can enjoy the best quality of life and standard of living. The Nova Scotia School Boards Association would urge the federal government to determine actual targets and corresponding appropriate levels of funding to eradicate child poverty, recognizing the need to develop integrated service delivery models to meet the needs of children at risk.

Two, ensure that adequate accountability and reporting measures are in place for any funding intended for a national children's agenda and early childhood development programs. There needs to be a process in place whereby the provinces are held accountable for the funds that go forward from the federal level.

Three, appoint a commissioner for Canada's children whose role would relate closely to the goals of the national children's agenda.

Four, work with aboriginal groups, the provinces and territories, and school boards to meet the distinct needs of off-reserve, aboriginal children in order to ensure that they enter the public education systems across the country on an equal footing with non-native children.

Five, continue to invest in adequate social infrastructure programs that can help and support schools and community groups.

The second goal is to provide Canadians with equal opportunity to succeed. The recommendations coming forward from the Nova Scotia School Boards Association are the following.

One, we urge that the federal government work with the provinces and territories and school boards to establish a Canada-wide program on technology and vocational education in order to provide students with the skills and knowledge necessary to compete in the global economy.

Two, work with the provinces and territories and school boards, as well as with the private sector, to develop a coherent strategy for making broadband access widely available to all communities, including the public educational institutions, by the year 2004. We are of the understanding that the National Broadband Task Force has provided some options that may be worked with.

Three, revise the Copyright Act through a balanced process that deals with all important Internet issues, including the educational use of the Internet in contract law.

Four, include the school boards in any future infrastructure programs that are provided. As an example, in 1984 the infrastructure programs that were provided did result in school facilities receiving some major repairs to roofs and heating systems. Schools are in desperate need of repair, environmental improvements, technical upgrades, and modifications to provide accessibility for special-needs students and the public.

The third goal is to ensure that Canada remains a major player in the new economy. The NSSBA recommends and urges the federal government to maintain its position on the GATS negotiations regarding the maintenance and preservation of the ability of provincial governments and democratically elected local school boards to regulate and to set policy and to act in the interest of Canadians in the area of public education.

Two, maintain its position by not making commitments regarding trade in public elementary and secondary education services when negotiating international trade agreements, and in particular in the GATS negotiations.

Three, work with the national education organizations to develop clear policies and guidelines for use when seeking commitment on education services in these negotiations.

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As a highlight from our presentation, I would like to cite six items. First is the need for the federal government to provide a social infrastructure to ensure all Canadians have a chance to realize their full potential. The federal government must continue to address not only child poverty, but children and youth issues, particularly in the form of justice. The commitment of the federal government to life-long learning must continue to be a priority, and we compliment the government for setting that down. It's a goal of our school boards too. A federal-provincial-municipal infrastructure program needs to be continued; however, there needs to be special considerations for school facilities.

Our parent organization, the Canadian School Boards Association, has raised the matter of trade in services with GATS and the FTAA. This matter should continue to receive attention from the federal government. And finally, the issue of the accountability of the federal government for funds allocated to provinces needs to be discussed at the federal level.

Our children, as we all know in this land of ours, represent the future of our nation, and there are only a few short years in which we can help them acquire the skills they need as contributors to our society. We must all work together towards the goals to ensure they live in a healthy and safe environment and that their needs are met, both at home and at school. We must ensure they acquire the technical skills necessary to compete in the global market.

On behalf of the Nova Scotia School Boards Association, I thank you for allowing us to have this opportunity to speak to you, and we do hope that some of the recommendations we have brought forward will have some attention paid to them during the budget discussions. We will be available to answer questions. Thank you.

The Chair: Thank you very much, Ms. Parrish-Zwicker.

We'll now hear from the MacKillop Centre for Social Justice, the director, Mary Boyd. Welcome.

Ms. Mary Boyd (Director, MacKillop Centre for Social Justice): Thank you, Mr. Chairperson.

I also represent the Maquila Solidarity Network and Action Canada Network, which is a coalition of groups formed for social justice.

The Chair: Are you speaking on their behalf as well then?

Ms. Mary Boyd: Yes.

Thank you for the opportunity to present our views here today. We offer them out of concern for the welfare of Canadians, especially those trapped in poverty.

Now that the downturn in the economy appears certain, the federal government must use its surplus of approximately $9 billion to assist those who will suffer the most. Spending the surplus will have the twofold effect of stimulating the economy and assisting those who are most in need. Furthermore, the government drastically cut its spending on social programs from 1994 to 1999 mainly by means of cuts to those programs, and this government went further with cuts to social programs than any other G-7 country and brought spending to its lowest percentage of GDP since 1949-50, to 9.5%.

The finance minister, we believe, should cancel plans to cut taxes to the tune of an estimated $17 billion, 83% of which would go to the wealthy. Instead, a concrete plan must be put in place to stimulate the economy to lessen the severity of the recession. People who will lose their jobs, along with those who are already suffering, should be the main beneficiaries of Canada's fiscal policy. Any tax relief should go to the lower and middle-income people, but according to Hugh Mackenzie of the Canadian Centre for Policy Alternatives, only 4% of tax benefits announced in the October mini-budget went to the poorest one-third of Canadians, while 40% of the benefits went to 5% of the population.

The bailout of the wealthy comes at a time when Canada has been singled out by the United Nations for its failure to combat poverty. Even delivery of the child tax benefit has been slow, and it has not as yet been extended to families on social assistance. The federal government has more flexibility than the provinces to deal with this. Some of the federal government's surplus must be allocated for relief of these people, who have seen their rights taken away with the CHST and have experienced much hardship through the workfare atmosphere that has been characteristic of the majority of Canadian provinces.

The CHST, which was instituted in 1995, continues to be a problem as it amounts to less than the two programs it replaced. Furthermore, the federal government has not made up for any of the cuts it made to welfare in the 1995-96 budget. It must provide more funds to health care in addition to the funds it gave in October 2000. The provinces have not recovered from past cuts, and the cost of pharmaceuticals is out of control. Other essential items in health continue to rise.

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Additional moneys for health care are also needed to stave off the current push for the privatization of health care and for the implementation of a two-tiered system of health care, a move that would be wasteful and at the same time very costly to individual Canadians. Research shows that when user fees are introduced, low-income earners become sicker because they postpone their visits to the doctor. Furthermore, it is unjust to pull out of the sharing of social assistance costs and leave the responsibility entirely up to the provinces. This is very problematic at any time but especially as we approach, or begin, a recession.

The current surplus of $36 billion in the EI fund needs to be spent on improved worker benefits like a longer eligibility period and increased benefits to workers, including part-time and temporary workers. Only one-third of unemployed workers currently draw employment insurance.

The $10 billion ceiling on equalization grants will cause huge problems for the smaller, poorer provinces, especially those in Atlantic Canada. Economist John Loxley recommends that Alberta be added to the existing five provinces in determining equalization flows or that all ten provinces be included in order to enhance payments to poorer provinces. This makes sense to us.

The war on poverty, including attempts to end child poverty, has been pushed to the back burner. In its place, we have entered into an unproductive war against terrorism. No one objects to the government's resolution to end terrorism, but there are more peaceful and effective ways of doing this than joining forces with the United States to fire bombs and missiles at innocent people in an already devastated country. We also run the risk of further inflaming the anger of terrorists and endangering the Canadian population.

Other economists share the views of Bruce Campbell at the Canadian Centre for Policy Alternatives, who suggests that an enhanced national public investment program targeted at urban renewal, housing, and environmental structure is needed to provide many more jobs and improve the overall social and economic health of the country. This overdue stimulus would be much more effective than any tax cut.

The government failed to deliver on its 1997 election promise to spend 50% of its surplus on social programs and 50% on the debt. Promises by the present government to continue with the 50-50 split if re-elected did not materialize, and spending is approximately at the 1997 level. Debt reduction and tax cuts far outweigh new spending on social programs.

Lowering interest rates is certainly a positive step and needs to continue, but this without an injection of new funding will be insufficient at this time.

I just want to add, after listening to the discussion of the last group, that pressures for changes in our health care system are not coming from just the public but from the transnational corporations and vested interests wanting to privatize health.

Also, I hope—and we recommend this—that some of the surplus will be spent to implement the recommendations of the Royal Commission on Aboriginal Peoples.

Hopefully, the Canadian government will not allow GATS to undermine our social programs. In fact, the GATS proposal as it now stands should be scrapped and revised in the interests of a more just Canada and a more just world. Thank you, Mr. Chairperson.

The Chair: Thank you very much, Ms. Boyd.

We'll now hear from Ms. Pauline Raven from the Annapolis Valley-Hants Community Action Program for Children. Welcome.

Ms. Pauline Raven (Regional Coordinator, Annapolis Valley-Hants Community Action Program for Children): Thank you. I'm glad for this opportunity to be here with you today.

My presentation is too long to make in five minutes, so I'm going to be jumping through by the headings that are laid out in the presentation you have before you; I'll just be highlighting some key points.

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Our overall purpose is to ask you as committee members to take a unanimous recommendation to the Minister of Finance. We want a greater social investment for the future of Canada's children in this next budget. We believe that children were largely left out of the year 2000 budget, and it is time to invest in kids and in the programs that support children in local communities.

I'm presenting from a particular perspective. I coordinate one of the Community Action Program for Children projects and a Canada prenatal nutrition program in Nova Scotia in a rural setting in Kings and Hants counties. I have colleagues all across the province in CAPC and CPNP programs and in the aboriginal head start program here in metro. I'm presenting from their perspective, and I've brought along endorsements for the presentation from many of those organizations; others are to be forwarded to you in the weeks ahead.

What we're hoping for is increased financial support for our projects in the next federal budget. There haven't been increases to these programs since their inception. We did manage to roll back a proposed cut to the programs, but there have not been ongoing injections of moneys even to keep up with the rising costs of operating programs—rent, heat, light, and additional staffing costs—as some of the mandatory costs have increased. We're asking for more money for the programs.

We're also asking for government to look at the scope of these programs and at how many communities do not have similar programs. We are constantly asked as a project to reach out beyond the areas we currently service. We're sad not to be able to do that, but we cannot offer an effective program if we spread ourselves throughout all the counties where we're located. We do need to see an injection so every community has the types of programs that CAPC, CPNP, and Aboriginal Head Start can deliver.

We also want to see more income support and more meaningful work opportunities for the families we work with. All too often, whenever they can find work, they're finding very low-paid work that is insecure, part-time, and seasonal and that doesn't allow them to fulfill their family responsibilities and be active members in the workforce as well. We want better work opportunities, and we do think that government has a role to play in that. We also want more sufficient income for those families for times they are underemployed or unemployed.

That's the rough gist of the whole presentation. Now I'd like to give you a little background.

The three funding strings I've referred to represent $3.5 million in federal funding to Nova Scotian communities. That's only the tip of an iceberg, so to speak, in terms of the number of dollars that would be required to service Nova Scotian communities with these programs. We are well evaluated, and we also take a track in providing programs modelled on things like the former “Head Start” program and the Perry preschool program in the U.S.A. From data from qualitative and empirical research there is good evidence that this type of model for delivering services to communities does work, that it does have a long-term impact on families, and that there are savings in the long run through spending the dollars now on these types of programs.

We would also like to stress that there's really no way for government to avoid spending money on children and on families. If we don't invest early, we spend the money later on, and we spend a lot more money later on. One example is that if we're unable to provide prenatal care and we end up with a child that has to spend a week in a neonatal unit here in Halifax, we're looking at a rise in costs per week. Those things can be prevented by providing communities with a Canada Prenatal Nutrition Program.

Similarly, when kids really get off the rails and end up in a young offenders facility, we're looking at $75,000 a year to provide a service we can't not provide because that child needs to be removed from his community. It would be much better to provide the service when the child is young and prevent many of these things from happening. It is preventable, and the empirical research is there to prove that it is preventable. You either spend the money now or you spend it later.

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There is also empirical research now that shows there is an immediate saving. At McMaster University, an empirical study was conducted that showed that when supports were given to single moms, there was an immediate saving because those single moms didn't end up in their doctors' offices. They didn't end up accessing emergency care as much as women who didn't have enhanced services.

It's really not even pay now or pay later; it's pay one way or the other. We would much prefer to see federal dollars spent in a way that doesn't cost families in an emotional way, and that provides children with the care they need and mothers with the care they need to do a good job raising the next generation.

There has really been no increased commitment to the level of funding received by programs. There has been increased funding to aboriginal head start programs on reserve, but there hasn't been increased funding to off-reserve programs.

Because of the shortfall, I really feel that many of the community action programs for children—the prenatal projects and the aboriginal projects—are in jeopardy. I see staff that are very stressed, as the demand for programs increases. Something has to give at some point. I think staff and volunteers are quite exhausted at the moment from trying to keep up to the demand without increased revenues to do so.

I think the current levels look good to pilot projects. We started in 1994 and it's now 2001. We know these programs are effective. It is time to invest and expand the mandate of the programs.

I want to move now to the need for increased income and child care support for vulnerable families.

These are things that need to be placed side by side with family support programs. I don't think one has to take priority over the other. They make a package that is whole when they're all there. Families need the income to make sure children and mothers and fathers have what they need to be healthy and well, and support children. They also need good child care for when they are engaged in the workforce. Those things just aren't in place in Canada.

The national child benefit is a good start, but we can see what it is doing. It is helping particular types of families much more than others. Single moms who cannot enter the workforce and may not have child care or a job that would make financial sense to take are being penalized at a family income level. The national child benefit is not working for those types of families.

We've also seen income tax relief. Again, that's not working for low-income families. It has really meant a $25 or $26 decrease in taxes for families with incomes under $20,000, whereas for families that are earning a lot more, there's a disproportionate gain in disposable cash. So income tax relief, as a strategy, isn't really helping families that need it the most.

Another thing that isn't being addressed is minimum wage rates. Increasingly we have a situation in Canada where people are unable to earn a living. There's a great scarcity of higher-wage employment. Canada has the second-highest incidence of low-paid jobs among the 29 industrial nations. We're telling people to go out to work, but as a government and a nation we aren't engaging with the marketplace in a way that ensures that when people work they have the ability to earn a living and take themselves and their children out of poverty.

We think there is a great need to address the specific needs of single mothers. They're becoming increasingly disenfranchised with the types of things that are contained in the social union agreement. They are being penalized for being lone parents. Some of the women we work with are very young mothers. They have a lot of growth and a lot of things to accomplish before they will get to a point where they can be independent as a family and be in a position to raise their children without our help.

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Other lone parents we're working with are people like your sisters and mine, very ordinary Canadians who have left marriages and are now single women with children, looking for a way to raise a family. They're plunged into poverty all too often when that happens and are looking to access the workforce and jobs through which they could support themselves and their kids. This is a considerable number of mothers and children in Nova Scotia.

I'll just wrap up.

The Chair: That was a wrap-up, wasn't it? I'm just kidding.

Ms. Pauline Raven: The parents who are using CAPC and CPNP and aboriginal head start programs do have many odds to overcome.

The last budget did focus, for the most part, on cuts for taxpayers and health care, but not on the kinds of social programs that the families we work with need most. So we're asking you to take a look at that and make a unanimous recommendation to the minister that it becomes top of the list for this budget.

We also really want to emphasize that there's no point in doing nothing about this, because you will have to do it—right now, in increased costs to the health care system, and down the road, in increased costs for the remedial services you're going to have to provide.

Thank you.

The Chair: Thank you very much.

Before I proceed to Graham Steele, the finance critic for the Nova Scotia New Democratic Party, I want to put the members of the committee on notice that I want some questions asked to Ms. Parrish-Zwicker, because she's going to be leaving. So right after Graham Steele's presentation, we'll focus on that one individual and then ask everybody else.

Go ahead.

Mr. Graham Steele (Finance Critic, Nova Scotia New Democratic Party): Thank you very much. Mr. Chairman and members of Parliament, I'd like to welcome you to Nova Scotia and to Halifax, and to Mr. Brison, welcome home.

I proudly represent the provincial constituency of Halifax Fairview, which is partly within the federal riding of Halifax, represented by Alexa McDonough, and partly in the federal riding of Halifax West, represented by Geoff Regan.

I'm also the opposition finance critic in the Nova Scotia legislature, and it's in that role that I'm appearing before you today.

Something I wouldn't normally do is actually read a written presentation. I'm currently on a committee touring the province on an entirely different issue, and I know it's sometimes a little more helpful for people not to read word for word. But for purposes of the record, that's exactly what I'm going to do.

What I'm coming here today to say to this committee, with respect, is that we believe a responsible government must produce a budget that balances fiscal health with the importance of providing for the protection, health, and well-being of our citizens. Let me say emphatically to the committee that in Nova Scotia, we would like to see the federal government invest responsibly in the well-being of its citizens in some very key areas.

As an aside, I would like to mention that I was born and raised in western Canada. At different times in my life, I have lived in different parts of central Canada, and I've now made my home in Atlantic Canada. So although I'm going to talk to you about a specifically Nova Scotia perspective, I'd like to think I'm doing it with due regard to national considerations.

Of the topics that we urge the committee to give consideration to, health care is unquestionably at the top of the list. We have argued consistently for a return to a greater federal share of health care costs. It is a fact that health care needs in Nova Scotia are higher than in other provinces due to the high proportion of the population with disabilities and high rates of cancer. I think you heard some of that from the previous panel. Yet we face funding shortfalls for badly needed infrastructure, a lack of family doctors and other health care professionals, and chronic underfunding of long-term care for our seniors.

Like other Canadian jurisdictions, we must provide fair wages and decent working conditions to health care workers. Just this past June, we had a real controversy in this province about wages being paid to health care workers. It was very divisive, very controversial, and that was only to bring them up to the standard in Atlantic Canada, never mind bringing the wages of our health care professionals up to a national standard.

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Our top priority, then, which we urge upon you, is to invest in health care so that the citizens of Nova Scotia can enjoy and expect a level of health services and health enjoyed by Canadians elsewhere. To do that requires a recognition on the part of the federal government that the total package of federal funding for health care should recognize population health and population needs, because regardless of their causes, those needs do add to the considerable burden on the health care system in Nova Scotia.

The second topic is transportation. Investment in transportation in Nova Scotia is vital. We believe the federal government has a responsibility to share the costs of making safer those highways that fall within the Trans-Canada Highway system. We do not believe the federal government has kept its end of the bargain in that respect.

Likewise the federal government must increase its strategic investment in the port of Halifax to put it on a level playing field with competitors in the United States, if Halifax is to thrive and grow as a world-class port, which certainly is the goal of everybody in every party in Nova Scotia.

It must also be noted that for a small province sitting on the edge of the continent, air transport is a vital link, yet deregulation and privatization have made it a very fragile connection for communities like Yarmouth, at the extreme southern end of Nova Scotia, and Sydney, at the northern end. The current instability in the airline industry makes us wonder if the pendulum has swung too far.

The third one is post-secondary education. The Nova Scotia School Boards Association has spoken very well about P to 12 education. I'm sure I won't be the only person to tell the committee of the tremendous importance of post-secondary education to our future, both to the province and the country.

Nova Scotia prides itself on its excellent post-secondary institutions, and that's why I'm here. I came to Nova Scotia to go to university, fully intending to leave when I was finished. Through circumstances, like marrying a classmate who was a Nova Scotian, here I am many years later, now sitting in the Nova Scotia legislature. But it was the excellent university system that brought me here in the first place.

We urge upon the federal government the need to recognize that Nova Scotia carries one of the heaviest burdens of paying for post-secondary education, despite having less fiscal capacity than most provinces. Here again, we urge upon the committee the idea that federal funding, as in health care, must take into account factors like the number of students in a given province. Nova Scotia serves a disproportionate number of students from elsewhere in Canada, and yet the funding formulas don't take that into account.

In the absence of appropriate participation from the federal government, student debt load has skyrocketed as tuition fees rise out of reach to many would-be students. In fact, one of the excellent universities in Nova Scotia, in Mr. Brison's riding, Acadia University, has the distinction of having the very highest tuitions of any undergraduate program anywhere in Canada. In this regard, the capping of the Canada health and social transfer is inappropriate and unwise and, in our respectful submission, must be removed.

Next is natural resources. Nova Scotia has an opportunity to grow its economy through the wise management of offshore oil and gas resources. We believe the federal government has a responsibility to work with Nova Scotia to ensure that the legal and regulatory regime works to the benefit of Nova Scotians, helping them to build employment, investment, and community opportunities.

In October 2000, the Nova Scotia legislature endorsed Brian Tobin's proposal for a new deal on offshore resource revenue. It was a unanimous vote on an NDP motion. All parties in Nova Scotia have joined to support the broad goals of the campaign for fairness that Nova Scotia, and in particular the Premier of Nova Scotia, has been conducting. That campaign is still evolving, and it has been portrayed in some quarters as getting a bumpy ride. But we ask all members of Parliament not to ignore the foundation of unanimity that exists in Nova Scotia on this issue of fiscal fairness.

The government will no doubt be facing great pressure to restrict new spending or to look at constricting existing spending in the economic environment that we find ourselves in.

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The government must act responsibly, as we move slowly forward in the wake of September 11. But I would like to say to the government and the committee, in no uncertain terms, that cuts to health and social programs, or even standing still with the way those programs are currently administered, are not appropriate or responsible responses to our current situation.

It is precisely at times like this when appropriate responsible investment in areas that are vital to the health and well-being of Nova Scotians are most needed.

Thank you very much.

The Chair: Thank you very much, Mr. Steele.

We're going to make just a little bit of a lineup change here. We'll go into the question period for the Nova Scotia School Boards Association, but then we'll go back and hear from Jeanne Fay, community legal worker, from Dalhousie Legal Aid Services. Then we'll go back to the general round of questions and answers.

Who has a question for Ms. Parrish-Zwicker or Ms. MacDonald?

It will be Scott Brison and Rahim Jaffer.

Mr. Jaffer.

Mr. Rahim Jaffer: Yes, I just have a brief question. When you were presenting your brief you said there needed to be greater interaction among the three levels of government, especially when it came to dealing with education. You said provinces needed to be accountable for funds that came from the federal level.

A great challenge, as you know, right across the country is dealing specifically with accountability and education, since it's a strictly provincial responsibility. One of the things we've always had to deal with is how to incorporate a better spirit of cooperation on that level.

There have been suggestions from CASA, a student group, on creating a pan-Canadian agreement on education to provide that better cooperation and accountability. But that also upsets a lot of provinces that say they want to be able to manage that in their own way, according to their own needs.

I wonder if you could give us some ideas on how you expect to create that better level of cooperation or accountability at the provincial level, when education is strictly a provincial responsibility.

Ms. Lavinia Parrish-Zwicker: I recognize that education is a provincial responsibility, but federal dollars, which are public dollars, are being disbursed to provinces, and they are being presented in more of a global presentation. Then the individual governments make their decisions on where those dollars are to be targeted.

We would like to see some focused dollars coming to the provinces. That would be one way of having accountability and ensuring that the money that came from the federal level was targeted for educational issues. Then the government in that particular province could make the decision that it would go toward educational issues, be it technology or the upgrading of buildings within the school system. That would be one way of focusing on it.

I come from the business world—Mr. Chairman will remember me from being at the lobby session for CSBA—and it's just simple accounting, good accounting. We are using public dollars, both federally and provincially, and there needs to be accountability in presenting those dollars, receiving them, and using them.

Mr. Rahim Jaffer: I think there's an assumption, though, that when those dollars are handed to the provinces they are handling them effectively and accountably. They usually have to report on their education spending in the provinces.

I think even Mr. Steele would agree that if you started at the federal level trying to intervene in that, you would be obviously questioning the competence and ability of some of those provincial levels of government to deal with education. I think that's where the problem comes in from the federal level, and that's where our challenge is. Maybe you can focus on that and how we could deal with that particular problem.

Ms. Lavinia Parrish-Zwicker: I appreciate those problems, but I guess I would go back to my areas as a businesswoman. We all recognize in Canada that we need to spend our dollars wisely and we have to be accountable for those dollars. I would hope that through partnerships and working together, the provinces and the federal government would be able to devise a system whereby people would feel comfortable with being accountable for the money they receive.

I am in no way saying that our own provincial governments do not use their dollars wisely, because I feel they do. But the school boards in Nova Scotia feel very strongly that they would like to see a portion or a share of those dollars come their way, or at least have the opportunity to have active discussion on it.

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We did apply, as an association, for active involvement around those infrastructure dollars, and we were told they were being targeted in different areas. We recognize that it would be nice to know, when it's the small people on the bottom who are asking for those dollars, that there is a system in place by which we can watch the process unfold and the accountability is there.

The Chair: Thank you.

Mr. Brison, then Ms. Guarnieri.

Mr. Scott Brison: Thank you, Mr. Chairman.

My question is on the issue of the federal government's role as well. We were talking this morning to people involved in the delivery of health care in Atlantic Canada, and there seemed to be a consensus that the federal government could play a role in identifying best-practice models anywhere in the world, or within Canada, and make them available to provinces as pilot programs, with cost sharing on specific initiatives both in health care and education—with provincial responsibilities and all the constitutional risks inherent in that.

This strikes me as a commonsensical way to proceed, where we could have the federal government playing a role in encouraging the provinces to act as laboratories in spawning new ideas and innovation.

Would that notion, which seemed to be agreed upon by the health care professionals, be shared within Nova Scotia from the school boards' perspective?

Ms. Lavinia Parrish-Zwicker: It's an interesting concept, and the way I would look at it, not knowing what the exact direction would be from the boards and the province, would be to deal with it as we do at the provincial level—ensure we are part of the process, that we are actively involved and there is an opportunity for open discussion in order to put that process into place.

Mr. Scott Brison: I have one more question, and this is on an issue of provincial policy. I'd appreciate the Nova Scotia School Boards' view of the tax credit being provided now for private education in Ontario.

I would be interested in the view from your organization, from a Nova Scotia perspective.

Ms. Lavinia Parrish-Zwicker: The Nova Scotia School Boards Association is a strong advocate and supporter of public education, and in regard to the issue of another province and a tax credit, we've not had those open discussions.

We support the public education in our province, and that's where we wish to—

Mr. Scott Brison: But you haven't taken a position in terms of....

Ms. Lavinia Parrish-Zwicker: No, not at this point.

Mr. Scott Brison: Thank you very much.

The Chair: Thank you, Mr. Brison.

Ms. Guarnieri.

Ms. Albina Guarnieri (Mississauga East, Lib.): It's 12 o'clock and you mentioned you had to leave, so I'll be very short.

You mentioned lifelong learning, and of course that's a recurrent theme. It's often said that the only time you can get access to training programs is when you get laid off and there are no jobs to train for. I'm just wondering, as you see students going through the system, do you feel students are sufficiently guided so there's a job waiting for them at the other end?

Do you think there should be coordination between let's say the education system training these young minds and the private sector, so we can fulfill the demands of the marketplace down the road?

Ms. Lavinia Parrish-Zwicker: The Nova Scotia School Boards Association would respond that we are seeing some of that happen in our province through partnerships and relationships with the universities and technical community colleges we have.

I recognize you're referring to the corporate industry, as it's done internationally in some countries. I think our young people here need to be given the options and be able to choose. They need to be able to recognize what jobs are out there for them.

We do have the STEPS program. We have cooperative learning within our universities and some of our high schools where the students have an opportunity to go out, if they show a strength, into a corporate company to be able to work in that area.

I become very concerned when I feel we're going to try to peg our children to a certain direction, because as we all know, any of us who have children in university or those of us who have changed our majors once or twice recognize, you cannot actually say at a level of say grade 11 or 12 that this is exactly where you should be in life. We would hope the options are there, and that's the direction we would take, along with some gentle nudging toward particular occupations and giving them those opportunities to examine them.

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Ms. Albina Guarnieri: It's a very enlightened approach.

About two or three years ago in the human resources committee there was unanimous endorsement of a proposal that suggested that in order to fulfill life-long learning commitments we always seem to force the worker to go to a training program only when he's fallen off and has no job, and somehow that doesn't seem to fulfill the needs of the individual. Time after time we saw the labourer, for instance, being forced to take a computer course, and you knew he wasn't going to get a job in an office. He was going to be on unemployment, but in order to get his EI he was forced to take this course.

One of the proposals that was circulated among the committee was that we should take a portion of the EI fund and actually designate a portion of it for retraining. The thinking was that the local janitor, and this could apply to a white collar worker also, would know what his needs are and what he would like to retrain himself for in the eventuality that his job would expire.

What would your reaction be to a portion of the EI fund being set aside so that people could retrain themselves while still being employed, rather than waiting until they're desperate and simply as a band-aid solution they attend a training course that really doesn't fulfill their needs?

Ms. Lavinia Parrish-Zwicker: I think the Nova Scotia School Boards Association would be pleased to see something of that nature put in place.

Ms. Albina Guarnieri: Thank you very much. It was actually unanimously accepted by the committee.

The Chair: Thank you, Ms. Guarnieri.

Ms. Parrish-Zwicker, you may leave.

Ms. Lavinia Parrish-Zwicker: Thank you very much.

The Chair: Thank you, and thank you for your input. And judging from the questions, of course you struck a cord with the committee.

We'll now hear from Jeanne Fay. Ms. Fay is a community legal worker for Dalhousie Legal Aid Services.

You have five minutes to make your presentation thereafter, Jeanne.

Ms. Jeanne Fay (Community Legal Worker, Dalhousie Legal Aid Services): I'll be short, and I do apologize. This is the only time I could get here.

The Chair: I understand.

Ms. Jeanne Fay: Mr. Chair and committee members, staff, guests, and fellow presenters, all of whom I'm happy to see, but some of whom I know, thank you.

Dalhousie Legal Aid Service is a community-based legal aid clinic in the north end of Halifax, which is traditionally a low-income and working class community. It's the largest urban neighbourhood of African Canadians east of Montreal and it's also the home of former Africville residents. I didn't put this in, but it's the home of many middle and working class people today. It's also the place where transient men and women from all over Canada come looking for work and more specifically line up for food at Hope Cottage.

Dalhousie Legal Aid has served this community and others like it in the greater Halifax area since 1970, and we've done that by providing legal aid in poverty law and other matters, by educating law students about poverty and representing people living in poverty, and by engaging in community development and law reform activities to address and change the underlying inequalities that cause the poverty, the racism, the violence, and the homophobia our clients endure.

That's what I want to talk about in the brief time I have with you today, attacking the underlying inequalities. Because I don't think we're going to make a dent in poverty in this country.... At least we don't seem to have made a dent in the 20-odd years that I've been involved in this work, and, quite frankly, I'm getting impatient that we do this, as I'm sure everyone is around this table.

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At this time in Canada's fiscal history, when Ottawa has a projected surplus of over $95 billion, notwithstanding the costs of engaging in the war on terrorism, we see, at Dal Legal Aid, little excuse for the increasing poverty in this country. For example—and I apologize for some of the mistakes on this document, it was produced very quickly this morning—Andrew Jackson and David Robinson in Falling Behind: The State of Work in Canada in 2000 make many observations based on Statistics Canada and other sources. Some of them are obvious and I won't reiterate them; they're there for you to see. I want to highlight some of them. One of these is that one-earner and young families are at greater risk of poverty in this country, and that speaks ill of us as a society I think in terms of the future.

First nations and aboriginal peoples, people of colour, and persons with disabilities face the greatest risk of poverty in Canada. That's unacceptable in any terms. As a result of the CHST—and I was surprised to read this, although I knew federal spending had decreased, but in fact according to those statistics in this book, federal spending on social, health, and education programs has dropped to its lowest rates in 40 years.

Tuition rates for students, the future of our country, have increased by 126% and debt loads for students have increased over 100%. I spoke to a class of first-year sociology students yesterday, and we talked about the differences between their expectations and my generation's expectations in terms of what the welfare state, which I'm proud of and proud to continue to fight for, was able to do for people of my generation but doesn't seem to be able to do for people in my children's generation.

The single highest increase in health care spending, and I know it's killing us here in Nova Scotia, has been drugs, and that's due in part to the federal law extending patent protection. Pharmacare in Nova Scotia—and I'm sure the Minister of Health, if he were here, would tell you the same thing—continues to increase almost out of sight as more and more people live longer and longer and need more and more medications.

Social assistance rates have decreased nationally, across the board, to as low as 25% of the poverty line. Whatever poverty line you want to use, and I know there's been debate in the country over the past number of years—and we have poverty lines from as low as Chris Sarlo's to as high as that of the Canadian Council on Social Development, whatever one you use—25% of the Statistics Canada poverty line is pretty low and is not adequate to even keep body and soul together in this country, nor is 50%, by the way, of the low-income Canada cut-off enough to keep body and soul together.

Another striking thing, in my view, is that minimum wage earning power has decreased by about 20% since 1976. Again, as people on the front lines, we don't always get to read this material to figure out what's going on, but certainly I can tell you that in my caseload there are more people now who are working and on social assistance than was the case 20 years ago. Why is that? It's not because social assistance rates have increased adequately in 20 years, but rather because minimum wage rates have not kept pace with the cost of living; they've decreased about 20% in the last 25 years.

Infant mortality and suicide rates have increased. Again, I fear that you may have heard, and you probably will hear, much more sophisticated and well constructed arguments than I bring about young people in our country, but I want to tie my statements to that group of people, among others. As a Canadian, I'm upset and shocked that we now have increasing infant mortality and youth suicide rates.

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If we use the human development index, and I guess it's the one the UN uses, the social well-being of first nations people on reserves in Canada places us 63rd in the world, far below our overall standing of—I know we used to be number one—number two or number three most recently. But we are 63rd in the world in terms of the social well-being of first nations people on reserves in this country.

We hear about this in the media. We hear about the horrific things that happen, but then it all seems to go away and nothing gets solved. In the old terminology, money gets thrown at it, but not in a way.... And I'm not suggesting that money doesn't help, because I certainly don't buy the thought that throwing money at a problem doesn't solve it. Throwing money at a problem does solve it as long as you have a good plan for how that money is going to be used.

The final points I want to make are about the GPI Atlantic. This recently released report looked at income distribution in Nova Scotia. I just had a look at it the other day when I was preparing to do some other speaking, and again, my mouth was literally hanging open. The poorest quintile of Nova Scotians are the poorest in the country. This is not a competition. In this part of the country we've always felt for and tried to support people from Newfoundland and other places who were worse off than we were, but now we're there. We are the poorest. Our poor are the poorest in the country. We have the second widest gap between rich and poor after Alberta.

This is what I'm talking about when I speak of the underlying problem, ladies and gentlemen. The richest quintile have 42% of the income in Nova Scotia and the poorest quintile has 4.9%. So the richest 20% of us in this province have 42% of the income. Now we're not even talking about wealth here; we're just talking about disposable income. And the same 20% of us, at the other end of the scale, have about one tenth of the income. There's something desperately wrong in a democracy, in a market economy—capitalism or not—if we can hold our heads up and think this is good.

I treasure the democracy we live in. Certainly after September 11 it's really important that we think about and rethink what democracy is. One thing democracy means to me, and means even more to me now since September 11, is equality. We cannot have equality as long as we keep producing statistics like this.

These statistics are no accident. That's the final point I want to make. The solutions are within our grasp. We've studied. I'm bringing up the issue of a guaranteed annual income. I know this is a hot button for people. Let's call it something else. The Europeans are now calling it basic income. We can talk about it in many different ways. There are some good programs. There are some bad programs. We've studied it at least three times, probably more. I've listed the three obvious ones that I think most people know about. As I've said, all of these proposals have been different to some degree or other with key issues revolving around adequacy of benefits and fear about work incentives. The left is usually worried about adequacy of benefits and the right is usually fearful that guaranteed income will kill work incentives.

But I would argue that at this point in our history with the federal surplus that we have, in the face of such economic disparities and inequalities in Canada, it's time to begin to discuss the option of some form of guaranteed income again seriously. We have guaranteed income for senior citizens in this country, but, for example, we have no guaranteed income for persons with disabilities. We have a patchwork of provincial and federal programs, but we have no guaranteed income for persons with disabilities or for single parents raising children.

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Again, I can't emphasize enough the importance of our children and our young people to the future of this country. Given the changes in our social assistance program here in Nova Scotia, for example, our Nova Scotia government seems to think the way out of poverty for people is to force people into the low-income wage market without adequate child care.

Again, they'll throw $400 at women for child care, but they're not putting any money into child care spaces, or adequate child care, or making any kind of adequate child care provisions. Women on social assistance are asking the question that I think, as a country, we need to ask—or say, rather than ask: “We want a choice. Many of us would choose to stay home and raise our children, because that's where we think we need to be and where we want to be, but you are not allowing us to do that. You want to force us to work at Tim Horton's and put our kids in inadequate or half-adequate or bounce-us-around-from-neighbour-to-neighbour facilities.” This has an effect on children's well-being over the long haul.

It's time to talk about a guaranteed income. In order to do that, we have to talk about tax reform, and not the kind of tax reform Mr. Martin has been proposing. A study from the United States of so-called tax reforms in this country since the 1970s shows that the upper-level incomes and corporations have benefited, while middle- and lower-income Canadians consistently see “lose” in tax reform. I'm not an expert in tax reform, but I certainly see the problem with how we tax ourselves in this country.

One of the particular problems is covered in point three under this paragraph: a study done by U.S. researchers suggests that the elimination of taxes on inheritances and gifts in 1970.... Now, I didn't realize that. I didn't realize that Canada is—what is it?—the only western country that doesn't have a tax on inheritance and gifts.

My daughter, who just finished her master's degree in social work at Hamilton, called me one day last year. She had just come from a social policy class where her professor had said to the class: “Do you know that the baby-boom generation is about to inherit...?” And it was gazillions. We're about to inherit billions of dollars, those of us—myself included—in the baby-boom generation. I'm going to pay taxes because my family's in the United States. I'm going to pay income tax to the United States government, but I'm not paying any income tax at all to the federal government in this country, and I think that's a crime. I will donate it, but the point is, there is no income tax on inheritances and gifts in this country.

This study also found that the massive tax reforms in the early eighties shifted the tax burden to the middle class and that the regressive changes in 1988, with the consolidated tax brackets, have created what this report calls an extremely favourable tax environment for the generally wealthy.

Derek Hum, who was the director of the GAI experiment—for some of you that might ring a bell: back in the 1970s in Winnipeg, the federal government did an experiment using the guaranteed annual income—says in a recent article, “Let the debates begin”.

Leger Marketing has reported just this fall that consistently across the country 60% plus—as high as 66% in some provinces—of Canadians surveyed favoured a guaranteed income provided by the state. I think, therefore, it's time to raise this important social policy issue. And we can afford it. These programs, the different proposals, and there are many of them, are—I think the terminology is “deficit neutral”. What you have to do is reform the tax system in order to pay for it. It means higher taxes for people at higher levels. It means graduating the income tax system much more than it's currently graduated.

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But what I would say to you this afternoon is that we cannot afford this increasing gap between rich and poor brought about by unfair taxes and economic programs. We cannot afford the decreasing earning power of middle- and low-income families who, as I understand it, are the engines of our consumer economy. President Bush is exhorting Americans to spend themselves out of the current economic malaise brought about after September 11. I find that silly, appalling, ironic—I can't come up with enough words for it.

I understand that we're in a market economy and that consumers and consumer spending are important parts of the market economy. But here we are, in this country, through our tax policies increasing the gap between rich and poor, meaning there are fewer of us in the middle class and in the lower middle class to spend money.

I don't know what the statistics are, but I don't think the truly rich are spending very much of their money in Canada. I mean, the Irvings' father went off to Bermuda or somewhere, didn't he, so he wouldn't have to pay taxes in Canada? It's not the poor we can't afford any more, ladies and gentlemen: it's the rich who are causing us the problems.

The Acting Chair (Ms. Albina Guarnieri): I'm sorry, Ms. Fay, but we're racing against the clock. Could you please make your final comments.

Ms. Jeanne Fay: That's my last point, about not tolerating this on moral and humanitarian grounds. Thank you very much.

The Acting Chair (Ms. Albina Guarnieri): Thank you very much. It was very thought-provoking. I'm sure your dissertation has provoked many questions.

Mr. Jaffer, please proceed with the first round.

Mr. Rahim Jaffer: Thank you.

I've just got two quick questions, and since there's time, my first one is to Ms. Ferguson.

I've listened to your presentation carefully. I thought it raised some interesting information I wasn't aware of. I just wanted to know offhand, from your experience with your counterparts across the country, what sort of support is there across the board? I've heard different things from different provinces about whether there is support for this national type of child care program. Maybe you can give me information as to what sort of support exists currently and whether there is unanimous support across the country from your provincial counterparts, from what you're hearing.

Ms. Elaine Ferguson: I would be giving you a perception from a child care basis—not necessarily from public opinion, but—

Mr. Rahim Jaffer: Are there people you talk to?

Ms. Elaine Ferguson: Do you mean among my colleagues?

Mr. Rahim Jaffer: Yes.

Ms. Elaine Ferguson: Well, the “Sign-on for Canada' Kids” is a national organization around promoting national child care programs, and there are many, many organizations that are part of it.

I'm also on the board of the Canadian Child Care Federation, which is made up of affiliates of child care organizations, professional organizations, and all the provinces and territories.

In my thirty years in child care too, this has always been a predominant thing. We feel that the federal government provides leadership to the provinces and territories in having a national child care program. We recognize that the provinces and territories have the jurisdiction around child care. However, if you had asked me two years ago if the first test of the early childhood development agreement that tests the SUFA would happen, I would have said no. But last September it was fine. So there was provincial and territorial agreement about federal partnership around early learning and care, of which child care is part.

We want quality child care such that all the choices the parents make are quality choices, that it is above minimum standards, that we are optimizing children's growth and also fulfilling the vision articulated in the early childhood development agreement. I think we do have vehicles and ways the federal government can, in partnership, take some of that responsibility. Often it is through the dollars.

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Mr. Rahim Jaffer: I appreciate that. Thank you.

My next and last question is for Mr. Steele. I noticed in your presentation—and I think you'd find a lot of support from at least my party on that front to renegotiate the deal you're currently working on...unanimously in the House...for the offshore resource revenues. I wish you luck on those negotiations. I think that's something that needs to be addressed, and I think it will help this part of the world, especially the economy here in Nova Scotia.

My question sort of stems from that. There are obviously different feelings on how to stimulate economic growth and on what needs to happen. Currently, when you look at some of the other provinces, for example Alberta, where I'm from, or Ontario, where there has been a different approach to how to get economic activity going.... In light of the development of offshore-resource-based businesses that, hopefully, will stimulate other forms of economic growth.... The attitude in other provinces has been to look at ways to make themselves more competitive in those environments either by lowering taxes or otherwise trying to stimulate the economy. This seems to have worked in some of these other areas, yet when you look at Nova Scotia, there has always been the fact that tax rates here—and people point to that—are generally quite high. In light of the new stimulus, namely offshore development and other forms of attracting businesses to raise incomes, and in light of other concerns many people have mentioned, what are some of the things you're faced with now or are dealing with to make a more competitive environment? Whatever we can do at the federal level to increase funding...there are things happening here provincially to encourage growth and prosperity for everybody.

Mr. Graham Steele: Thank you very much for that question.

I'll start by identifying what will very definitely not work. It seems very clear now that the way to long-term sustained growth is not through the direct subsidy of economic development. There has been an alphabet soup of development initiatives over the years: some successes, some failures, and some enormous failures. It just doesn't seem to work, but it's still going on—not just on the part of the federal government but on the provincial government's part too.

Lower taxes will not work either. This is a province in fairly desperate financial shape. The amount of money we pay every year just to pay interest on the debt is proportionately higher, much higher, than in any other province. We are a revenue-poor province, yet we still try to provide services at the same level other provinces do.

It seems to me that the real answer is precisely what our government is doing—and if it surprises any of you here that I, as a New Democrat and the opposition finance critic, say that our government is doing the right thing, please take due note of that. There's unanimity here among all the parties that the way forward is to let us keep our own resource revenues. Let us work with those resource revenues. This is an historic, maybe never-to-be-repeated opportunity for Nova Scotia to make its own way and become a “have” province. Unfortunately, what is happening now is that as we take in resource dollars, we lose revenue through the equalization formula.

We are saying that the way forward is to allow us to keep more of that resource money—not forever, just for a while. Let us use that money to develop the spinoff industries that come with having oil and gas. It belongs to us. Let us develop the petrochemical industry that can come from having those great resources, which are only beginning to be tapped. Let us use our own money to do it. That's the way forward, and on that point we agree completely with the Conservative government we have right now. I might add that the provincial Liberal Party agrees as well.

The Chair: Thank you very much, Mr. Steele.

We'll have a five-minute round for Mr. Nystrom, Mr. Brison, and Mr. Murphy.

Mr. Lorne Nystrom: I have two questions, one for Mr. Steele and one for Ms. Fay.

I'd like to ask Graham what he thinks the appropriate level of federal funding for health care would be. When public health care first came into effect, it was established on a 50-50 cash-sharing basis between the provinces and Ottawa. It went into the tax-point argument later on. As a result now, in terms of the cash put up by both levels of government, about 15% is from the federal government and about 85% from the provinces, varying from province to province, of course. When you consider tax points, it's probably 30%, or thereabouts, from the federal government.

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The other part of the question concerns an argument we had this morning, that instead of basing federal funding on a per capita basis, it should be based on your demographics. Some provinces have older populations that cost a bit more. It should also be based on the economic reality of the province, because Alberta can afford it more than Nova Scotia, for example—that was the argument made this morning.

Those are my two questions to you.

Mr. Graham Steele: Thank you very much for the question. The answer is that I don't have a dollar figure; I don't have a percentage. But I support, and we support completely, this idea of basing funding on population health needs, which is something that is recognized by the provincial government, maybe not quite as perfectly as we all would wish, but the level of government that doesn't appear to recognize it in any significant way is the federal government.

I think the really important point is, equality is not treating differently situated people similarly, but recognizing people's differences and treating equal people equally. You've all heard some version of that.

The fact is that Nova Scotia's population is not equal to other provinces. We do have unique and heavy population health needs, and so I support that idea, and we'll let the true experts, like George Kephart and others who were here in the earlier panel, decide exactly what that would translate to in terms of dollars.

The other thing would be to simply remove that cap from the Canada health and social transfer. I believe it was there for fiscal reasons, and I understand the fiscal needs, but it does not serve the purpose of the program, which is to improve health and social programs.

I would suggest those two things. What that translates into in dollars, I don't know.

Mr. Lorne Nystrom: Ms. Fay, my question to you is on the guaranteed annual income. What is your vision of how this would happen, in terms of what programs you would eliminate for the guaranteed annual income?

We've had endorsement of the idea in principle by people like Robert Stanfield, many years ago. We've had Pierre Trudeau look at it, and our part of the NDP has looked at it. What is your vision in terms of how it would be set up? Would we eliminate a number of social programs, roll them into a guaranteed annual income across the country, and if so, what are they, and how do you tie the tax system into that?

Ms. Jeanne Fay: I'm not an expert. I just decided to become an expert because I think we need to start talking about this again.

What I can say so far, and what I can say from my perspective as an anti-poverty activist for 30 years, is that we have to get rid of needs-tested, punitive social assistance programs. I have never seen one that doesn't hurt the people it's supposed to help more than it helps them.

The way we've structured social assistance cannot help but demean people. There are all kinds of work disincentives built in. Contrary to popular opinion, most people who are on welfare would work, and as I said, many of them do work. So in my view, social assistance should be first to go out the door.

After you get past that one, it gets complicated, I guess. I've read Jim Stanford on guaranteed income. The labour movement is worried about losing UI, although that argument may not be as strenuous as it was back when we had a real UI program in this country.

I think the material from Europe suggests social assistance and unemployment insurance to begin with, and then an expanded child benefit. So the basic income would be at the lower end of the scale and would decrease, the way the child benefit does, as you go up the income scale.

Mr. Lorne Nystrom: Thank you.

The Chair: Thank you, Mr. Nystrom.

Mr. Brison.

Mr. Scott Brison: First, I want to thank all the guests today for their presentations and interventions. They're very helpful.

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My first question is for Mr. Steele. I want to congratulate Mr. Steele on his presentation. I thought it was very constructive.

On the campaign for fairness initiative, which has gained all-party support in Nova Scotia, the Alberta precedent is one that I don't believe the committee is aware of. When equalization was first introduced, Alberta continued to receive its full equalization, or rather keep all of the petroleum revenues, until the point at which it reached the formula level whereby it was no longer qualified for equalization.

So there is a precedent for this if you look at Alberta. I think that's something as a committee we should take a serious look at. Perhaps we can look at some of that information as we're writing this report because I think it's a very important issue.

Any initiative that gets complete all-party support in a province, and all-party support in the House—in fact the federal Liberals from Nova Scotia, and the New Democrats and Conservatives all support this—I think deserves the support of this committee or at least our strong consideration. So congratulations on the fairness initiative.

Mr. Graham Steele: Thank you very much.

Mr. Scott Brison: I have a concern, Ms. Fay, relative to the GPI Atlantic information, because when I look at that it is shocking. Some of it seems a little counterintuitive, but I would like to have the report and—

Ms. Jeanne Fay: No problem. I've just put my card on it, and you can have it if you courier it back to me.

Mr. Scott Brison: I can make a copy and send it back to you, because I would like to see it and the methodology you used.

Ms. Jeanne Fay: Yes. GPI stands for the “genuine progress index”. It is a new way of looking at figures, so you can have that.

Mr. Scott Brison: I appreciate that.

On the free trade issue, the Atlantic Provinces Economic Council, which is a very centrist group, by and large, did an evaluation of Atlantic Canada, and particularly Nova Scotia, and the impact of free trade. It was quite unequivocal that Atlantic Canada has benefited and that average incomes have actually been affected positively by free trade.

It's difficult because we can't compare where we are now to where we would have been without it, so we can't do it in absolute terms. There may have been all kinds of other factors that have impacted the changes over this period of time. But APEC's analysis was quite different. In any case, I look forward to reading it.

Ms. Jeanne Fay: Yes, it's very interesting to compare the two. Absolutely.

Mr. Scott Brison: I agree.

On the guaranteed annual income, Mr. Nystrom is right; I think all parties have looked at this. Bob Stanfield, as a federal leader of my party, looked seriously at this.

How do you address the issue of disincentives? Some economists, when they're looking at the notion of guaranteed annual income, are saying that somehow it would reduce the incentives for people to work. I recognize that part of the problem with the notion is its name, because in fact what it would do is eliminate a lot of the overlap between federal-provincial programs and all the confusion and difficulties and cross-purposes of those things.

I'd appreciate your view on this as a social worker, because when you mention this to people, I think it's the first concern people have.

Ms. Jeanne Fay: That's what I noted. I don't know whether I actually had it written down as such, but certainly that's the question for people from centre to right when you talk about a guaranteed income; that's one of the concerns. Of course, what that leads to is a lowering of the amount, which then means that the people on the left are not going to agree with it because it's too low. So I think the work incentive is the key issue.

I would make two points, and the first is that in my view we have to understand that this whole issue of incentive, work incentive in particular, is an ideological question.

I was on CBC Radio the other day with an economist from Prince Edward Island, and I challenged him to show reports, documentation, where somebody had proved categorically that providing people with more money that you don't have to “work for”—and I'm going to talk about work in a second in my second point—creates a disincentive.

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In my view, people work and are able to work when they're healthy, when they're adequately housed, and when they're satisfied that their children, if they have children, are being looked after. That's when people work. This notion that we have to somehow make people a little hungry in order to make sure they have a heightened work incentive, I think is really an ideological question from the old days that we really need to let go of. Again, I'm not an economist, so this is not to say that at some point there isn't a point at which people say, gee, I really would be better off if I did this rather than that. But at the levels we're talking about I don't think it's a factor.

The second point I'd make is if we're talking about guaranteed income in this country, and I'm saying let's start a new debate, we have to talk about an expanded notion of work. In my view, women who raise their children are working. In my view, women, and it's mostly women who are looking after elderly parents or neighbours, are working. In my view, all the folks down at Club House Connections, literally two or three doors from here, people with mental and physical disabilities who go in there every day and volunteer, are working. A guaranteed income is not going to hurt their work incentive because they're already doing this work for less money. A guaranteed income would only make it a little more comfortable and easier for them to do that work.

The Chair: Thank you.

Pauline.

Ms. Pauline Raven: I do think we have Canadian studies that show that the whole idea of this whip of deprivation,—if we deprive people enough they'll have the incentive to go out and do something for themselves—is really wrong. The McMaster study clearly shows that when people are well supported, that's when they then get ready to become more independent. That's where their incentive comes from. It's from a feeling of self-respect within their communities and being supported within their communities.

I think it's a misnomer. I think people do have an incentive to do well for themselves, for their children, and for their communities, and if we as governments and individuals support them in doing this, that's exactly what they're going to do. People want to be active in their community and they want to be gainfully employed in their community. Whether it's volunteer work or paid work, that's what they want to do.

Mr. Scott Brison: I appreciate that. I'm very interested in issues of tax reform, and the notion of a guaranteed annual income is one that does cross a wide range of ideological views. I don't think you should consider it as purely a left of centre notion, because I think you would find there's....

Ms. Jeanne Fay: [Inaudible—Editor]

Mr. Scott Brison: Yes, and Nixon was in favour of a lot of things actually—

The Chair: We must move along.

Mr. Scott Brison: I have one last point and it is on the notion of inheritance tax. We did have an inheritance tax in Canada until the Carter commission recommendations in 1971. But the inheritance tax, when it was eliminated. was replaced by capital taxes and capital gains taxes, which did not exist before. So prior to 1971 people did not have to pay taxes on capital gains. That was the whole deal with the inheritance tax. If we got rid of capital taxes now and brought back an inheritance tax, we could promote Canada as a great place to live but a bad place to die, or something like that. But there was a notion or a methodology, a trade-off for that.

The Chair: Thank you very much, Mr. Brison.

Final questioner, Mr. Murphy.

Mr. Shawn Murphy: I want to thank everyone who presented here today. It will be very valuable to us in our final report.

My first question is directed to Jeanne Fay, and it's to get a clarification. In your report you indicated in the third paragraph a surplus of over $95 billion. Is that a typo, $95 billion?

Ms. Jeanne Fay: No, I don't think so.

The Chair: That's over five years.

Ms. Jeanne Fay: It's over five years, a projected surplus over five years.

Am I wrong, should it by $95 million instead of billion? I don't know.

Ms. Pauline Raven: The projection for those figures that I've seen are like $65 billion over five years going up to the year 2004.

The Chair: It's higher than that, but for those years we've already put over $30 billion towards the debt, so some of the billions you've already talked about have been accounted for.

Ms. Jeanne Fay: Right.

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The Chair: That includes also the $20 billion that went to health care, and then you have $100 billion for tax cuts. I don't want anybody to leave here thinking that Mr. Martin, in his economic fiscal update, is going to announce a $95 billion surplus, because he won't.

Ms. Jeanne Fay: My apologies. It wasn't meant to mislead. It was just the figure I had read as to what the projected surplus was in five years.

The Chair: I know you weren't misleading us.

Mr. Shawn Murphy: My next question, Mr. Chairman, is to Ms. Boyd. And I should point out that Ms. Boyd is from the beautiful city of Charlottetown, so we're from the same neck of the woods.

Ms. Boyd, you follow these issues very carefully and you come to this committee with a lot of knowledge, but in your submission you covered a lot of territory. There are a lot of issues you feel the government should deal with immediately, and we are, as we just saw, into a period where there may not be as much money as some people expect. If there were one thing—let's approach it with a rifle rather than a shotgun—in the budget you'd really like to see, what would it be?

Ms. Mary Boyd: The CHST cut back so much and gave a lump sum of money to be divided and for different groups to scramble for, and I think that money should be targeted for health care, higher education, and social assistance and that the federal government has to share costs. We've said over and again that there still isn't enough money going into health care, and we really need to look at that. Also, I said that capping equalization at $10 billion is going to really harm the Atlantic provinces, so remove that cap. It's really important.

Mr. Shawn Murphy: Thank you, Mr. Chairman.

The Chair: Thank you very much, Mr. Murphy.

On behalf of the committee, I want to thank all panellists, those who are still here and those who left, for their input.

As a housekeeping item, the second session for the afternoon will begin at 1:45.

The meeting is adjourned.