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37th PARLIAMENT, 1st SESSION
Sub-Committee on Veterans Affairs of the Standing Committee on National Defence and Veterans Affairs
EVIDENCE
CONTENTS
Thursday, April 25, 2002
| ¿ | 0905 |
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The Acting Chair (Mr. Bob Wood (Nipissing, Lib.)) |
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Dr. Paul Gully (Senior Director General, Population and Public Health Branch, Department of Health) |
| ¿ | 0910 |
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Mrs. Wayne |
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Dr. Paul Gully |
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The Acting Chair (Mr. Bob Wood) |
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Mrs. Elsie Wayne |
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Dr. Paul Gully |
| ¿ | 0915 |
| ¿ | 0920 |
| ¿ | 0925 |
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The Acting Chair (Mr. Bob Wood) |
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Mr. Roy Bailey (Souris--Moose Mountain, Canadian Alliance) |
| ¿ | 0930 |
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Dr. Paul Gully |
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Mr. Roy Bailey |
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Dr. Paul Gully |
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Mr. Roy Bailey |
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The Acting Chair (Mr. Bob Wood) |
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Mr. Bachand (Saint-Jean) |
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Ms. Nancy Garrard (Director, Division of Aging and Seniors, Centre for Healthy Human Development, Population and Public Health Branch, Department of Health) |
| ¿ | 0935 |
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Mr. Claude Bachand |
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Dr. Paul Gully |
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Mr. Claude Bachand |
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Dr. Paul Gully |
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The Acting Chair (Mr. Bob Wood) |
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Mr. Claude Bachand |
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Dr. Paul Gully |
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Mr. Claude Bachand |
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The Acting Chair (Mr. Bob Wood) |
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Mrs. Elsie Wayne |
| ¿ | 0940 |
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Ms. Nancy Garrard |
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Mrs. Elsie Wayne |
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Dr. Paul Gully |
| ¿ | 0945 |
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Mrs. Elsie Wayne |
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Dr. Paul Gully |
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The Acting Chair (Mr. Bob Wood) |
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Ms. Sue Morrison (Manager, Palliative Care Secretariat, Health Policy and Communications Branch, Department of Health) |
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The Acting Chair (Mr. Bob Wood) |
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Ms. Sue Morrison |
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The Acting Chair (Mr. Bob Wood) |
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Mr. Roy Bailey |
| ¿ | 0950 |
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Dr. Paul Gully |
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Mr. Roy Bailey |
| ¿ | 0955 |
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The Acting Chair (Mr. Bob Wood) |
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Mr. Claude Bachand |
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Dr. Paul Gully |
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Mr. Claude Bachand |
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Dr. Paul Gully |
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Mr. Claude Bachand |
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Dr. Paul Gully |
| À | 1000 |
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Mr. Claude Bachand |
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Dr. Paul Gully |
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Mr. Roy Bailey |
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Mr. Claude Bachand |
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The Acting Chair (Mr. Bob Wood) |
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Mrs. Elsie Wayne |
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Dr. Paul Gully |
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Ms. Nancy Garrard |
| À | 1005 |
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Mrs. Elsie Wayne |
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The Acting Chair (Mr. Bob Wood) |
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Ms. Nancy Garrard |
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Mrs. Elsie Wayne |
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The Acting Chair (Mr. Bob Wood) |
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Dr. Paul Gully |
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The Acting Chair (Mr. Bob Wood) |
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Dr. Paul Gully |
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The Acting Chair (Mr. Bob Wood) |
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Dr. Paul Gully |
| À | 1010 |
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The Acting Chair (Mr. Bob Wood) |
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Dr. Paul Gully |
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The Acting Chair (Mr. Bob Wood) |
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Dr. Paul Gully |
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The Acting Chair (Mr. Bob Wood) |
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Ms. Nancy Garrard |
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The Acting Chair (Mr. Bob Wood) |
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Mr. Roy Bailey |
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Dr. Paul Gully |
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Ms. Nancy Garrard |
| À | 1015 |
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The Acting Chair (Mr. Bob Wood) |
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Mr. Claude Bachand |
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Mrs. Elsie Wayne |
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Dr. Paul Gully |
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Mrs. Elsie Wayne |
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Ms. Nancy Garrard |
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Mrs. Elsie Wayne |
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The Acting Chair (Mr. Bob Wood) |
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Mrs. Elsie Wayne |
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The Acting Chair (Mr. Bob Wood) |
CANADA
Sub-Committee on Veterans Affairs of the Standing Committee on National Defence and Veterans Affairs |
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EVIDENCE
Thursday, April 25, 2002
[Recorded by Electronic Apparatus]
¿ 
(0905)
[English]
The Acting Chair (Mr. Bob Wood (Nipissing, Lib.)): Good morning, everybody. Welcome to the subcommittee on veterans affairs.
This morning we would like to welcome Dr. Paul Gully, who is the senior director general, population and public health branch. With him are Nancy Garrard and Sue Morrison, who is the manager of the palliative care secretariat.
As you know, Doctor, we're doing an extensive study on veterans affairs, on aging, especially with our veterans, and we welcome your comments this morning. The floor is yours.
Dr. Paul Gully (Senior Director General, Population and Public Health Branch, Department of Health): Thank you very much.
Good morning. I'm certainly pleased to be here on behalf of Health Canada and my colleagues.
What I'd like to do is provide some information about the trends in health as the Canadian population ages and relate that to implications and trends in health care. Hopefully that will give you some broad context in your deliberations.
I also want to signal just before I start that Health Canada and the Department of Veterans Affairs actually have been working together for many years on a variety of issues, in particular sharing information on home care, but also we have a joint initiative relating to falls prevention. Both departments participate in a federal interdepartmental committee on aging and seniors' issues, and we do have a number of collaborative projects. In particular, we've created a caregivers resource directory, and there is seniors online, as well, on the Internet.
The second slide relates to the key messages. Underlying those messages is the fact that, as you will know, the number and proportion of seniors in the Canadian population has grown steadily. That's related to a decline in birth rate and an increase in life expectancy. Over the next 30 to 40 years, as the baby boomer generation reaches senior years, the proportion of elderly people, seniors age 65 and older, will double, from 13 percent now to 23 percent in the year 2041.
Aging has important implications for the health system, but rather than being a distinct concern for us, it's more an issue that influences how we work within the department.
If I could just say one or two words about the population and public health branch, it has national responsibilities for disease and injury prevention and control, health promotion, and promotion in support of actions related to the wider determinants of health. A great part of our role is the generation of knowledge and the interpretation of information and knowledge to produce policies and to either run programs or work with others to develop programs on particular issues.
I will give the highlights of disease and disability trends among seniors and relate that to health system use.
The two main themes running through the presentation are that the health of aging Canadians can be improved--I believe that's positive--and that the health system can be adapted to respond to their needs.
The first key message is that the prevalence of many diseases and disabilities increases with age, but this can be reduced.
I'm going to make the presentation totally in English, if that's acceptable to the committee, but I can obviously respond to questions in French, if you wish.
The fourth slide relates to chronic conditions, and these are conditions reported by seniors. Underlying this is the fact that life expectancy has increased over the past century. A person currently 65 years of age can expect to live an average of 18-1/2 more years.
Canada has one of the highest life expectancies in the world. At birth, Canadians have a life expectancy of just under 80 years. The top country, Japan, has a life expectancy at birth of just over 80 years. There's very little difference between the two countries.
The health of seniors has been improving since the 1970s. Rates of diseases such as heart disease, high blood pressure, and arthritis have declined slightly. As you can see from the graph, arthritis obviously increases, as reported by seniors, as they get older, but high blood pressure seems to go down. The reason for that is probably that the people who have uncontrolled high blood pressure do not get old.
¿ (0910)
Heart disease has increased, but I think it's important to realize that this is reported conditions. Therefore, one has to look at this information with a certain amount of judgment. Cataracts have increased, and diabetes has remained about the same. I think the awareness of diabetes has actually increased.
Slide five has to do with death rates among seniors. These are numbers of people who have died per 1,000 of the Canadian population. The total for all causes of mortality has in fact dropped. This is primarily due to a drop in heart disease, which is a trend we've seen across all ages within this country for a variety of reasons, probably relating to changes in smoking, diet, and exercise. However, the death rate from cancer has increased, and the death rate from respiratory diseases, which would include influenza and pneumonia, has remained about the same.
Slide six has to do with activity limitation or handicap. More seniors than non-seniors report having long-term limitation of their activity, and the prevalence of that is greater among older seniors.
I believe the next one is slide six.
Mrs. Elsie Wayne (Saint John, PC): We don't have the last one you just did.
Dr. Paul Gully: Am I confusing you with the numbers? I'm sorry.
The Acting Chair (Mr. Bob Wood): No, it's not that. I think there's a page missing.
Mrs. Elsie Wayne: Yes, there is. That's what I just said. The page on the death rates is missing.
Dr. Paul Gully: I apologize. We will get that to you.
Mrs. Elsie Wayne: Thank you.
Dr. Paul Gully: So now, the one on activity limitations.... There has been a decline in the prevalence of long-term activity limitations since the 1970s, but that decline holds mainly for seniors aged 65 to 74. The younger seniors are more active, and I think we probably know that. You can see the limitation among women and men for those aged 75 is about 40 percent, which is considerable and important.
The next slide is on injury. This is not reported injury. These are hospitalizations--people admitted to acute care hospitals for injury. The major cause of activity limitation among older adults is unintentional injury, especially falls. As you can see by the graph here, the proportion of injuries accounted for by falls increases as age increases. Over the age of 85, the vast majority of injury hospitalization relates to falls.
Seniors, as a whole, account for more than one-quarter of cases of hospitalization due to injury overall. But it is important in seniors because it is an important cause of death, or results in death, but also results in placement in long-term care institutions, whereas in the younger, accidents either usually result in death or hopefully result in rehabilitation and not long-term institutionalization.
The next slide is the prevalence of dementia--reduction in mental capacity. This is a very broad category. These data come from a study called The Canadian Study on Health and Aging, which has been going on for a number of years and is a collaboration between Health Canada and academics. It has brought forward some interesting and objective information. You can see here--this is 1991 data, but it still does hold true--that the prevalence of dementia is that 37 percent of women over the age of 85 are diagnosed with dementia. It is higher for women than men, and that probably relates to a number of issues, such as the fact that men may have suffered from other diseases, not necessarily dementia. There is a gender difference.
Very few people under 65 have dementia, but it increases dramatically over the age of 75. There are an estimated 60,000-plus new cases of dementia diagnosed each year, and it is expected that by the year 2031 the number of seniors with dementia will triple.
There are some causes of dementia, such as what we call vascular dementia--dementia related to hardening of the arteries, which is possibly preventable and relates to the prevention of heart disease. However, diseases such as Alzheimer's are not, as far as we know at present, preventable. So it is an issue.
The next slide makes the point that 50 percent of what we call premature deaths and 70 percent of physical and mental decline accompanying aging are related to modifiable risk factors. The older one gets, the more influential are one's behaviours. If one has genetic traits to a particular disease, that tends to be more important as a cause of mortality or sickness when one is younger. The older one gets, the influence of behaviour is much more important. Therefore, the influence of smoking, physical inactivity, poor nutrition, and lack of social support, which relates in a complex way to what we call “common risk factors”, become important. Those are potentially modifiable, and the courses of injuries, as I've said, obviously can be changed.
¿ (0915)
The population and public health branch does have responsibility for a number of strategies and initiatives that will hopefully promote prevention, such as the diabetes strategy, the Canadian strategy for cancer control, the Canadian breast cancer initiative, and funding for community initiatives under the population health fund. As I've said before, we do have a partnership with the Department of Veterans Affairs on falls prevention, which we could say more about later if you wish.
The second key message is that for obvious reasons seniors do use--related to what I've said already--more health services than non-seniors, but future demand is difficult to predict. The next slide makes reference to hospitalization rates. Seniors are admitted to hospitals more than other age groups and stay longer. Those aged 65 and older account for in the order of 35 percent of all discharges from hospital and 52 percent--that's half--of all patient days. They only represent 12 percent of the population, so they certainly are admitted more and also spend more time in hospital.
Now, as do other groups, seniors certainly benefit from huge changes in medical practice in terms of length of admission, day surgery, day care, and so on and so forth. But there's been little decline in long-term stays in acute care hospitals. Those individuals who get admitted to hospital for an acute problem but cannot leave because of a shortage of either home care, palliative care, or long-term institutional care are an issue. As our population gets older, that will become more of an issue unless we combat that.
The next slide is on the number of medications taken by seniors. As you can see here, for those 75 or older upwards of a quarter of individuals are taking three to four medications a day. Now, there's an upside and a downside to medication. Medications are there and they are given for a reason. They probably do prevent a number of hospitalizations and hopefully do prevent long-term disability. However, are these the right medications? Are they given in the right dose? Are they prescribed in the right dose? Are they taking the right dose? Do the individuals for whom they are prescribed have sufficient knowledge? Are they given sufficient information by their physicians?
It is a major issue. It is complicated. As you'll know from the papers today and the story about increased drug costs, it is complex because there are more drugs there. They probably do benefit individuals, and they do keep people out of hospitals. But the medical profession and caregivers have to make sure they're prescribed appropriately.
The next slide is on the population receiving home care. Most recipients of home care are seniors--64 percent are 65 and older--but the services do vary. Whereas non-senior recipients do in fact receive home care and home care nursing, with seniors half use a houseworker, 42 percent use nursing, 29 percent get personal care, and 16 percent have meal preparation. It's the whole spectrum of home care they receive. For those aged 80 and over, 22 percent do receive home care.
The next slide shows the portion of seniors in long-term-care institutions. The actual percentage of seniors in long-term-care institutions, those 65 and older, has in fact fallen since 1971. This relates over the last 30 years to the introduction of more home care services and more long-term-care facilities. However, there will obviously be a requirement for long-term care as people get older. They remain healthy longer but then do reach a stage where they need long-term care. This obviously relates to the provision of home care before the need for long-term care as well.
¿ (0920)
Future demand is difficult to predict. An analysis was done, and a projection from 1971 data would have indicated that the length of hospital stays would actually have been 50 percent higher than they are now. That's just to illustrate the point I made before about huge changes in health care.
And like younger people, seniors now experience fewer and shorter acute hospital stays, but greater uses of drug treatment. I mentioned that before.
Recent cohorts, recent age groups of seniors, are healthier than their predecessors. And there is a lower prevalence, as I mentioned, of heart disease, high blood pressure, and arthritis and activity limitation, especially among the younger seniors.
The last key message relates to specific care and support issues, of course.
The continuity of care, as we've alluded to already, is important, and seniors with chronic conditions require a combination of social and health care support provided over time. But the requirement for care and support is often fragmented, and often care tends to deal with individual crises rather than anticipating or preventing them. Instead of there being a continuity of care, people enter the system when a crisis occurs.
As I stated here, 80 percent of care received by a senior is in fact provided by informal helpers. Approximately 2.1 million Canadians provide informal care to frail seniors. A significant number of those caregivers are seniors themselves. And if you think of the age distribution, from 65 to 85 plus, that's not necessarily surprising. But it is important, because caregivers themselves are at risk for physical health problems and depression, and exhaustion by caregivers can lead to institutionalization. That has been cited as a cause of elder abuse.
Other specific issues relate to housing and residential care. There is a need. There was a study by UBC that showed that the rates of very long-term stays in acute-care hospitals have not decreased. I've made reference to that before. So it is projected that the requirement for long-term-care beds will be 170 percent higher in 2041 than in 1999. However, if home care and the supply of affordable supportive housing is increased, that could be reduced--according to the study--to 61 percent. So it could be markedly reduced by the provision of other forms of housing and residential care.
The issue comes with dementia care. As pointed out here, 49 percent of seniors with dementia live in the community. That does put strain on the community and on those caregivers, which I mentioned already. And 50 percent of seniors in institutions have moderate to severe dementia, which means the care required in those institutions has to be applicable to those demands. We've referred to the important increase in the numbers of individuals with dementia.
¿ (0925)
Because seniors take more medications, there is a need for more knowledge about optimal dosage for older adults and increased knowledge of adverse side effects. Drugs are well screened before they're licensed, but there is a question about the age groups for which they are screened, for example.
Health Canada has funded major research programs on these issues through the previous national health research development program, and we do produce professional education material to promote appropriate drug prescription and monitoring. We do know that of the drugs taken by seniors, 18 percent to 50 percent are not used appropriately.
End-of-life care.... Quite clearly, 75 percent of deaths occur among seniors, but the demand for care in a variety of settings--in the home, in hospitals, in hospices, and long-term care--increases. And as the health needs of seniors near the end of life become more complex and are less predictable than those in adults who die young, many health professionals will not have received the training they need to look after the aging population. In addition, older adults often have a smaller social support network to deal with those issues.
Health Canada has established a palliative care secretariat, represented by Sue Morrison here today, to foster and coordinate action at a national level to improve palliative care. The department has funded the development and dissemination of a guide in relation to end-of-life care for seniors.
That is the end of the presentation. I hope this information might assist you. I will be pleased to take questions.
The Acting Chair (Mr. Bob Wood): Thank you very much, Dr. Gully. It certainly will assist us as we continue our journey here to find out and make sure that veterans are getting their proper health care.
We will open the floor for questions. Some of our members have to leave shortly, so we will start right away with Mr. Bailey.
Mr. Roy Bailey (Souris--Moose Mountain, Canadian Alliance): Thank you, Mr. Chairman.
Thanks for the presentation.
As the chair has mentioned, we are looking at the care of seniors who are veterans, but when it comes to age it doesn't matter if a person is a veteran or a non-veteran, similarities exist.
Coming from the province of Saskatchewan, where we happen to have the highest percentage of seniors of any province, when I heard your presentation it made me wonder about a province putting approximately 42 percent of the provincial budget into health care and, from hearing what you've said, expecting that the cost is going to increase.
I don't want to put you out on a limb, but surely what we have at the present time is barely meeting the expectations of our people, particularly our seniors. What is it going to take to maintain what we now have? I'm not talking about expanding it, but if we put the same amount into the program for our seniors now, and you've shown on the graph that the demographics are changing rapidly, how are we possibly going to deliver the service we have now--which is lacking in many cases--in one generation?
¿ (0930)
Dr. Paul Gully: There are challenges I alluded to, which obviously would apply to many parts of Canada, including Saskatchewan, such as the geographic isolation of individuals who may wish to receive their care close to home or may wish to go into long-term care close to home. I am aware that in Saskatchewan a number of facilities have moved from being hospitals to being long-term-care facilities, and I think this would be beneficial to those individuals.
One response will be the issue of prevention and hopefully keeping people healthier for longer. One of the concerns we have does relate to the ability of the health care system to promote health. This is a challenge that I think we would all want to have examined, because, as we've said, seniors are healthier for longer, and therefore the demands for high-cost care hopefully will be postponed, which then relates to medication and so on.
It will require, I think, some rebalancing, some rethinking as to how we spend the dollars we spend now. There are some answers I've alluded to, but it will mean we will have to think widely and broadly beyond traditional health care or even physician-provided care.
That's sort of a general response.
Mr. Roy Bailey: Thank you.
You alluded to something that to me is very important. You mentioned, Doctor, that it is quite apparent that medication is certainly a remedy to long-term care, because of the type of medication now available. If you're going save on the long-term care that would normally be institutional care, and we can provide the patient with the medication to prevent it, should we not balance the cost with more money going into the pharmaceutical part, thus saving without any additional money?
In our province, where I know a lot of seniors, the pharmaceutical cost is one of the biggest costs. It seems to me we're maybe not putting our money in the right place for the pharmaceutical portion of it.
Dr. Paul Gully: I realize it's a point that has been made. It certainly has been made to the Romanow commission. I think the information we've given you could support it.
Mr. Roy Bailey: Thank you.
[Translation]
The Acting Chair (Mr. Bob Wood): Go ahead, Mr. Bachand. You have the floor.
Mr. Claude Bachand (Saint-Jean, BQ): Thank you for that highly interesting presentation, Dr. Gully. In fact, your focus wasn't specifically on veterans. Would you say that the physical, mental and health conditions of veterans are such that they have more or less the same profile as the one you presented in your study?That's my first question.
Ms. Nancy Garrard (Director, Division of Aging and Seniors, Centre for Healthy Human Development, Population and Public Health Branch, Department of Health): Thank you for your question.
They share more or less the same profiles, except for the fact that most veterans are men and men and women are different. Basically, however, these individuals are afflicted with more or less the same conditions and illnesses.
¿ (0935)
Mr. Claude Bachand: I see.
I would now like you to clarify something for me regarding jurisdiction. To my knowledge, Health Canada is fully responsible for first nations health care as well as for health care on military bases, which includes hospital care and so forth. Perhaps this is covered in DND's budget, although I'm not certain about this. Could you shed some light on the subject for me? It's clear to me that the federal government has complete responsibility for Sainte-Anne-de-Bellevue. however, veterans in my riding who require hospital care fall under provincial jurisdiction. Have I understood it right, namely that Health Canada is responsible for first nations and veterans health care services provided in federally run hospitals and on military bases?
[English]
Dr. Paul Gully: If I could respond in English, it would make my response more clear.
The responsibility for the care of veterans, at least in institutions, is under the Department of Veterans Affairs. As I understand it, for first nations who are not veterans, if they are on reserve, it is the responsibility, in part, of Health Canada. First nations off reserve would be the responsibility of the provincial or territorial governments, except for certain non-insured health benefits for which they are reimbursed.
Does it answer your question?
[Translation]
Mr. Claude Bachand: Oui, c'est parfait.
I listened closely to your presentation. Later, we will be talking about the Romanow report. Several provinces, including Quebec, feel that Ottawa isn't doing enough or shouldering its share of the burden in terms of transfers to the provinces. Many persons and premiers, including the Quebec Premier, have been critical of the situation, arguing that they have reached maximum capacity in terms of taxing people and that in light of the aging population, costs are set to increase. There is less and less funding available in provincial budgets for health care needs, most of which are tied to the aging population.
Do you think the current situation is somewhat unbalanced and that, owing to the anticipated surplus again this year, Ottawa should focus more on health care and transfer more funds to the provinces?
[English]
Dr. Paul Gully: As you could see in the presentation, certainly in the parts of Health Canada concerned with the cost of health care and the transfer of funds from the federal government to the provincial and territorial governments, the issue of aging is of major interest. It is considered in every discussion we have with the provinces and territories. I'm sorry, I can't be more specific with that answer.
[Translation]
The Acting Chair (Mr. Bob Wood): You have two minutes remaining.
Mr. Claude Bachand: Could you give me an idea of Health Canada's budget?
[English]
Dr. Paul Gully: Actually, I cannot tell you that. I wouldn't wish to quote a figure off the top of my head. I might say that almost 50 percent of the budget does relate to first nations and Inuit health. We would have to get back to you with that information.
[Translation]
Mr. Claude Bachand: That's all for now, Mr. Chairman.
[English]
The Acting Chair (Mr. Bob Wood): Thank you, Mr. Bachand.
Ms. Wayne.
Mrs. Elsie Wayne: Thank you. I don't have to wait, do I? I thought maybe you were going to say, well, I'm the only Liberal here, I'll do it.
The Acting Chair (Mr. Bob Wood): No, no.
Mrs. Elsie Wayne: I want to thank Dr. Gully and Nancy and Sue for being with us today.
Back in the early 1960s, I think it was 1963, all of the veterans hospitals--with the exception of Sainte Anne's Hospital in Montreal--were turned over to the provinces. So when you were replying to Claude as to whether veterans hospitals are still under the jurisdiction of the federal government, you mentioned that they fall under the Department of Veterans Affairs still.
The reason I ask that is because my veterans hospital in Saint John was taken down. It was magnificent, it really was. The care there was fabulous. Then they just built a little tiny hospital, Richwood. So we have over a hundred veterans waiting for beds.
I fought for, and did get, an addition, but every bed was for Alzheimer's. Every veteran entering that addition had Alzheimer's, and they filled the addition within two weeks.
When we were at Sainte Anne's last week, we were really impressed. It's magnificent. They have wonderful care. We would like to see that same level at all of our veterans hospitals.
Dr. Gully, they were talking about dementia and Alzheimer's. At that time--correct me if I'm wrong on this, Mr. Chair--I think we were informed that some of the specialists have come together. They did research and they're finding some medication they feel will help it. They're going to try to...
What we want to see, Dr. Gully, is that the federal government make sure that what Sainte Anne's finds through its research and all such information is relayed to all of these other veterans hospitals across the country, to help them as well. So I am wondering if, through our Department of Health, that is being discussed with the Department of Veterans Affairs and National Defence, and so on, to make sure that does take place.
¿ (0940)
Ms. Nancy Garrard: I think there's just a natural synergy between the Department of Veterans Affairs and at least the part of Health Canada that looks at seniors issues in general. As you know, the veterans population is, on average, older than the current population of Canada. We can learn so much from the experience of taking care of the veterans that has a wide applicability, so we started on a formal initiative with respect to falls prevention, because it is a preventable condition. We feel that we can make great strides in keeping seniors and veterans healthier longer in their own homes by specific attention to falls.
We know that with expected rates of dementia, what looms ahead for all Canadians is how to manage this issue. Nobody would wish Alzheimer's on anyone. Science and research, and we are putting money into the research side of it, is still very baffled on what causes it. We're getting a little bit of a better handle on what seem to be the most common risk factors, but whether these are the cause or the effect is not clear.
There have been some strides made in medication, particularly at an early stage, and some strides made in earlier diagnostic tools to identify Alzheimer's. It's one of those very hard diseases to be sure of. We are working with Veterans Affairs and certainly with Sainte-Anne-de-Bellevue Hospital, which has a national, if not international, reputation for the quality of the service. One would really wish that quality of care for all Canadians, and certainly all veterans.
In our department, we are trying to make sure that the best information is available for health professionals, as well as for the general population. We have a number of public information avenues and programs that we work on.
Mrs. Elsie Wayne: Dr. Gully, you referred to arthritis. As you reach a certain age, it gets more prevalent and worse. Could you tell me why that happens in a person's body? I need to know, because I have it.
Dr. Paul Gully: When it relates to osteoarthritis, it's a disease of, let's say, the body being less capable of movement than it was previously, and to a certain extent that may be preventable up to a point. I think one notices arthritis when one gets older as well because if you have other difficulties, and you're perhaps slowing down for other reasons, you would notice the arthritis more. It becomes more generalized rather than being one joint, for example.
¿ (0945)
Mrs. Elsie Wayne: Since last Friday, everyone across this nation knows my age, because of Mike Duffy, so they know now, probably, that I have arthritis. I'm taking Vioxx. When I went to get my hair done at the hairdressing shop, I picked up a magazine and started reading it and there was this page on Vioxx. It said it can cause rashes. It can cause this, it can cause that. I didn't know whether to continue to take the Vioxx, so I stopped.
Dr. Paul Gully: Actually that's a very good illustration. Vioxx is an extremely powerful drug and it's extremely beneficial. However, there are certain people who shouldn't take it--people with heart disease, for example. There are some specific issues, and notice has just been sent out to physicians relating to it. It does become between you and your physician. Often the amount that one takes for osteoarthritis, as opposed to rheumatoid arthritis, is much lower. It does relate to the more general issue of how well informed physicians are and how well informed the patients are in terms of demanding the information they need.
The Acting Chair (Mr. Bob Wood): Thank you very much, Doctor.
I have a quick question, and then we'll get on with Mr. Bailey.
I want to ask Ms. Morrison about palliative care and how your secretariat works in conjunction with the Department of Veterans Affairs--if it does or if it doesn't. How does that come together, if it does?
Ms. Sue Morrison (Manager, Palliative Care Secretariat, Health Policy and Communications Branch, Department of Health): Palliative care is part of the whole continuum and spectrum of care, so in large part, the provinces are responsible for palliative care, as they are for other types of care, in terms of actually delivering services and making sure programs and services are available. The need for palliative care has been highlighted in several studies, most recently in a Senate committee report, and it has been recognized.
Health Canada established the secretariat to begin to put together a national strategy. Of course, in doing that, we've established an interdepartmental committee to look at things that can be done at a federal level. As well, we're working toward establishing some links and common work with interested provinces. In terms of Veterans Affairs, they're represented on our interdepartmental committee and are working with us to develop a plan so that we will do our complementary and relevant things in our own areas of responsibility.
We're fairly early on in the development of that plan, so I don't have a whole long list of things that Health Canada is doing versus what Veterans Affairs is doing. Certainly Veterans Affairs has been interested and active in participating in our interdepartmental working committee.
The Acting Chair (Mr. Bob Wood): Is there any timeframe on that committee of when it has to have a report done, or is it open-ended?
Ms. Sue Morrison: There's no timeframe for a report, no.
The Acting Chair (Mr. Bob Wood): Thank you.
Mr. Bailey.
Mr. Roy Bailey: Thank you.
This is a general question for all of you, or any one of you individually.
It seems to me that with the modern news and the extensive zeroing in on health care on a national level, it's taken on somewhat of a negative look. We're looking negatively towards it.
I'll give you an example. You check out a weekly news supply, and it varies from time to time, but a health story from any province soon becomes a national story. My feeling is that we negate the progress we have made in the delivery of health care because of the negative press, which they grab very quickly.
I personally would inform the chairman and others that this old age business does not directly relate to chronological age. I was just writing down some of my kinfolk who have died. Uncle Willie was 104, Uncle Orville was 98, and my father was 98. So if you think you're getting rid of me soon, that's not likely to happen. We take that pride within a family.
I said to an industry the other day, “You are being hit very hard because of the movement afoot and you're not retaliating”. I'm talking about the biotech industry. They are constantly getting the news. If you're going to deal with an emotional issue and you don't use your factual issues to counteract it, you'll lose every time.
Now, let's look at health care. I went back and tried to get as much information as I could on what's happened in the last hundred years. I could only get it from the U.S., but it would be very close. A hundred years ago, the average lifespan--if we take theirs as being ours as well, and it didn't classify the difference between male and female--was 48. Today it's just slightly over.... Well, let's say it's 80.
Why aren't we dealing with some positive things? I believe mental health.... Those people who are living alone, particularly the widows, seem to concentrate more and worry about this. If we could continue to get some positive things out in health care, rather than the continuous negative.... I think the Department of Health should deal with that in all provinces. I think it would just make people feel better, period. I was wondering if you could comment on that.
¿ (0950)
Dr. Paul Gully: We do make a great deal of effort to publicize what we think are the good things we do. Unfortunately, it's up to the editors to decide what they print. Often it is easier for a journalist to look at what is on the web, a publication on the web, for example, or to look at a press release from a drug company or a biotech company. It takes a shorter time to do that than to interview us about the good stuff we're doing.
Perhaps as the baby boomers get older there will be much more pressure from them that they will want to see something different in what they read. It's something perhaps we have to work on.
Mr. Roy Bailey: I have one other question.
I also come from the province that has the highest percentage of native people, and that's growing very rapidly. They are big consumers of care. That in itself is a bit of a divisive thing. Naturally, it is if you live near or around where they are.
That care is covered by the federal government, but it's something like the situation where our vets don't have vets hospitals. We get a feeling there when you're talking with the vets and from the information letters I get that vets are not being considered, and they suggest they are being ignored for care.
Now, we have the same thing erupting in my constituency in my province, and I get stacks of letters claiming that there is favouritism in the care delivery because this person can't complain, but these people will. It's a real problem we have, but I'm not asking you to address it. I will suggest to you that in tenDepartment years it will be a huge problem in certain areas of Canada with the accusations coming about the delivery of care.
¿ (0955)
[Translation]
The Acting Chair (Mr. Bob Wood): You have five minutes, Mr. Bachand.
Mr. Claude Bachand: I'd like to briefly discuss Health Canada's mission. It was my understanding that to date, the only direct services you provided were to first nations living on reserves. This means that Health Canada's mission consists primarily of conducting studies, promotional campaigns and that sort of thing. Am I wrong, or is this a fairly accurate description of Health Canada's mission?
[English]
Dr. Paul Gully: Yes, the provision of health care to first nations is a responsibility on the reserve. Part of that responsibility has been transferred to a number of bands, so the number of individuals who are in fact directly cared for or provided services by Health Canada has changed markedly.
The provision of care off reserve is very complex. Your question relates to the promotion of health on and off reserve, is that correct?
[Translation]
Mr. Claude Bachand: My question is much broader than that, Mr. Chairman. When aIl is said and done, I'm wondering if maybe Health Canada is confined to playing a certain role which, aside from services provided to first nations on reserves, consists of doing studies and promotional campaigns aimed at Canadians and Quebecers.
[English]
Dr. Paul Gully: The programs we offer have related to particular issues; diabetes is an example. Diabetes programs are carried out in collaboration with the provinces and territories. Often the circumstance would be that our regional offices, of which we have six across the country, would say that we have a program relating to diabetes, partly relating to surveillance or prevention, and that we would wish to promote community support programs. We would do that in collaboration with the provinces, so there wouldn't be overlap and there wouldn't be duplication.
[Translation]
Mr. Claude Bachand: My next question concerns the famous five national pillars. I can't name all of them, but I do recall that one of the pillars is universality of services and health care, as well as free access to them.
It was always my understanding that Health Canada was a guardian of these pillars. In view of the pressures being felt by the provinces, something I alluded to at the outset - I think Mr. Romanow addressed this matter as well - the provinces are now being forced into privatizing certain services, jeopardizing in the process these five sacred principles. Shouldn't there be room for greater flexibility? For example, when a province contemplates introducing hospital user fees, the federal government steps in and threatens to reduce transfers if it follows through with its plans because one of the five pillars is being attacked and that is unacceptable. Shouldn't the federal government show more flexibility in terms of national standards so that the provinces can explore other possible options ? Because, by all accounts, it would seem the federal government cannot transfer more money to the provinces.
[English]
Dr. Paul Gully: They are questions that are policy questions for Health Canada, not issues I would really feel expert to respond to.
One could ask another question, though, as to what place public health services have in the five pillars. It's an open question.
Obviously, Mr. Romanow is looking at all the issues at the present.
À (1000)
[Translation]
Mr. Claude Bachand: Personally, how do you feel about this?
[English]
Dr. Paul Gully: I don't have a personal opinion.
Mr. Roy Bailey: You're a smart man.
[Translation]
Mr. Claude Bachand: I have no further questions, Mr. Chairman.
[English]
The Acting Chair (Mr. Bob Wood): Mrs. Wayne, you have five minutes.
Mrs. Elsie Wayne: Thank you very much, Mr. Chair.
Dr. Gully, when I was mayor of Saint John, and prior to that, the gentleman who was mayor when I was first elected as counsellor was a senior. He asked me one night to go to a meeting. It was in east Saint John and he wanted me to go there. He said it was a group of seniors and he didn't know what they were doing.
I went. A gentleman from the provincial department of health was there, as well. There were about 20 seniors. They were looking for some financial assistance from the local government because they wanted to expand.
There were seniors who said they no longer had to take medication, because they were involved with seniors groups and weren't sitting home alone depressed. I helped them. I continued to help them when I was mayor.
We have 34 seniors clubs in Saint John now. Recreation seems to be something that is good. You'll see them walking through the malls. They have T-shirts on and are seniors, etc.
At our veterans hospital in Saint John, the Ridgewood one, with the cutbacks in health care, they took away the recreational program. Actually, it was an activity program, where they made crafts and things, that they had to cut back on. It's through the province. They now determine how much is for the veterans, I guess, not the feds.
I saw a great difference. I go out quite often after church on Sunday. I was there last Sunday. The men used to sit and do crafts. They were happy and it was like a family affair. I used to buy a lot of Christmas gifts from them. Now they sit or lie in their beds.
Do you see that such activities help seniors, when they're kept motivated, busy, out with others, and so on?
Dr. Paul Gully: I'll ask Nancy to respond to it.
First, we do base this on evidence. I think sometimes programs can be introduced without good evidence necessarily. We would like to gather evidence, or ensure evidence is gathered, so seniors or others who wish to promote this kind of activity have good knowledge to do so.
Mrs. Elsie Wayne: Right.
Ms. Nancy Garrard: I can only reinforce your message that the research and evidence tells us that the feeling of being socially engaged or feeling valuable probably at all stages of life is important, but particularly in seniors. As one sometimes loses one's physical and mental abilities, that ability to feel you're contributing or being part of a broader community is extremely important.
We have certainly noticed across Canada that all levels of local government and the United Ways and community charities have struggled over the past 10 to 20 years to give this support. But I think there is some real strength in Canadian volunteers. It's again one of those positive stories that seniors are major league volunteers.
We're seeing a big boom here, and I'm really optimistic that the commitment to work with all groups at risk, including seniors and veterans, who may need someone just to come in and visit, or to sponsor some of these activities, for which many of the materials are very low in cost.... So I think there is certainly a recognition among professionals and caregivers, among the organizations that work closely with seniors, that this is an important factor.
We from Health Canada are trying to get that idea about social engagement and activity to people, and I think others, the sectors, are picking it up. I'm always incredibly impressed by the diversity of responses you see across this country, these wonderful experiments that happen in small towns or big towns and that are bringing together not only one generation but many generations, whether they be through churches or volunteer sectors.
À (1005)
Mrs. Elsie Wayne: On that, Mr. Chair, when we travel to Toronto or out west to our veterans hospitals, based on what Nancy has just said, I think we should ask whether or not they have the volunteer sector coming in to help them. Given the positive results for our veterans and everyone by doing that, if we find a hospital that needs to have some assistance, we, through Nancy and Dr. Gully, should help them to get them involved with that.
The Acting Chair (Mr. Bob Wood): Good idea.
Ms. Nancy Garrard: During the International Year of Older Persons we did give some recognition to some of the long-term volunteers.
Mrs. Elsie Wayne: But it comes under the federal government's jurisdiction, and they have more funding than others. That's our problem, Nancy.
The Acting Chair (Mr. Bob Wood): I have one question, Dr. Gully. Are you in favour of more home care to our veterans, rather than long-term-care institutions? We do have a home care program, and we wondered if maybe it should be enlarged.
Dr. Paul Gully: I think it obviously depends on the needs of the veterans. Individual veterans, one would hope, would have continuity of care so that whatever level of care was most appropriate to the individuals would be available. Certainly it's clear that home care, palliative care, hospice care, and other forms of care can perhaps prevent admission into long-term-care institutions.
The Acting Chair (Mr. Bob Wood): Looking at this chart you gave us--and correct me if I'm wrong here--a lot of the conditions you have mentioned here I think could probably be administered at home, could they not? Maybe they can't, I don't know. That would be the chronic conditions. You have arthritis, blood pressure, cataracts, heart disease, diabetes.
Dr. Paul Gully: To a greater or lesser extent, but then someone could have, say, acute dementia, which is particularly important, but there are obviously other circumstances where dementia plus other chronic conditions.... And perhaps the person could have diabetes, if it was unstable, for example, and needed some institutional care, and so on and so forth. As I've said, it depends very much on the individual, and this is where I think assessment of individuals and the ability to do that is very important.
The Acting Chair (Mr. Bob Wood): I jotted down something you said in your presentation; you said “right medications” and you said “major issue”. Can you elaborate on that a bit?
Dr. Paul Gully: There are, as I alluded to, powerful medications available, which have been of great benefit to seniors and others, but seniors have to be more carefully cared for and perhaps more regularly assessed in terms of their response to medication, because that response is going to vary more in a senior than it would in a young person. So that means there would have to be a close relationship between the individual and his or her physician, and the individual is going to have to ask questions of the physician and actually ask, “Am I getting too much, taking account of the fact that I am a senior?”
Even though more and more seniors are going to be looked after by physicians, I don't think physicians in general perhaps are trained in the care of the elderly as much as they might be. That is going to be another issue to be considered.
À (1010)
The Acting Chair (Mr. Bob Wood): Maybe an education program, because speaking for myself or anybody, I think, with all due respect to you, people have a lot of confidence in their doctor, and when the doctor says this is what you need, or this is what you want, I don't think a lot of people question it. They feel that they're in the hands of a professional and this person knows they need x amount of medication, whether they do or not. That's a problem, isn't it?
Dr. Paul Gully: I appreciate your confidence in the medical profession, but I think the more powerful drugs there are.... They're still fairly general in terms of their application. Every individual is different, tso there has to be tailoring. Perhaps in the future we'll be able to look at genetic make-up to say this drug is better for this person than another person, and be able to modify the doses, but we're not there yet.
So I don't think it's inappropriate for patients to demand of their physicians to ask questions. Perhaps the younger individuals coming up will be more demanding, and I don't think that's a bad thing, to be honest.
The Acting Chair (Mr. Bob Wood): I don't think it is either, but I just think we've always looked up to doctors in saying they're mostly always right, and we just don't get a chance to say, hey, maybe I don't need that much.
Dr. Paul Gully: I believe they should demand that. I still do some medical practice, and I do welcome someone actually saying they've looked on the Internet and.... To some extent, that's a problem. In some sense, the patients may have more information than the physicians. But I think most physicians would welcome that.
The Acting Chair (Mr. Bob Wood): Nancy, you were looking like you wanted to say something.
Ms. Nancy Garrard: As just a supplement, if I could, clearly our research shows us that today's seniors have an incredible trust in their physicians. They are a major deliverer of health messages. And you're quite right that if the physician says you should take this medication, the seniors do.
What we're finding, of course, is multiple doctors and polypharmacy, where patients may not tell one doctor about another medication, or they make take over-the-counter drugs, or they may take herbal remedies, or they may have two drinks at dinner. All these drugs, in combination, particularly over a long period of time, can cause problems. So we are at least trying to give some tools and information to empower the person himself or herself, seniors or anybody, to go there and ask those questions and keep track of them, because we do see situations of medication problems showing up in emergency departments.
The Acting Chair (Mr. Bob Wood): Thank you.
Mr. Bailey, you had a quick question.
Mr. Roy Bailey: As an observer, and certainly not trained in this field, I know my wife has five people she calls on each day she is home, and if she doesn't, there's a bit of depression that exists within those individuals.
Is there any correlation? I know for a fact that weather has a great deal to do with how a person is feeling, particularly with older people. Has any research ever been done to show that the Canadian winter or the prairie winter takes a heavy toll on our seniors, but the more visitation they have and the more they are in contact with other people, the depression is less steep than it would be otherwise? Do we have any statistics to show climate having anything to do with mental depression in the elderly?
Dr. Paul Gully: There is certainly data that show there are individuals who respond less well to the smaller amount of light during the wintertime. The answer to your question is I don't know, but having lived in Saskatchewan, I know the weather is never good.
Nancy may....
Ms. Nancy Garrard: I think as we begin to learn more about mental illness and mental problems, we are learning a little bit more about how to diagnose depression.
There's certainly enough evidence that with many seniors, physicians are not recognizing signs of depression. They're often dealing with major loss. One can expect to lose most of one's friends, and spouse and family. You live alone. You are dealing with a lot of life changes at an older age. And if that's compounded by weather that you perceive as keeping you trapped in your home, no doubt it is a concern.
But I think as we begin to try to find other ways of connecting seniors.... Those telephone exchanges are good programs--I'll phone three friends today. We're also finding that those seniors who are connected by the Internet, who are now getting daily e-mails from their grandchildren and friends around the world, have actually been helped.
So I think we have to face the weather, unless we can find a way to change our Canadian weather--even in Saskatchewan.
Mr. Roy Bailey: Thank you.
À (1015)
[Translation]
The Acting Chair (Mr. Bob Wood): Anything further, Mr. Bachand?
Mr. Claude Bachand: No, that's all. Thank you.
[English]
Mrs. Elsie Wayne: I have one.
When I was at our veterans hospital last Sunday afternoon, I found out that there were citizens who were taking the beds at the veterans hospital, instead of veterans. We have about a hundred veterans in need of veterans beds.
Were you aware that other than Sainte Anne's Hospital, all the other veterans hospitals in Canada can turn beds over to citizens, rather than veterans? That's the first I knew of it, when I went in there. That really, really worries me.
Dr. Paul Gully: I suppose at Sainte Anne's, all those beds are under provincial jurisdiction. Therefore they would have the ability to--
Mrs. Elsie Wayne: Yes.
I guess we have to take it up with the minister, Mr. Chair, to get this straightened out. We need to do it. It's an urgent matter--it truly is. We had to open up a little ward in one of our hospitals to put those veterans in, because there weren't any veterans beds for them. But here the citizens were taking the veterans.... That really shocked me.
Ms. Nancy Garrard: I do believe this is a policy decision within the Department of Veterans Affairs, and maybe talking to someone in Veterans Affairs would help clear the air.
Mrs. Elsie Wayne: I'm sure we will.
Ms. Nancy Garrard: I just have to assume that there were no veterans prepared to move into Sainte-Anne-de-Bellevue, because I presume that they--
Mrs. Elsie Wayne: No citizens can go to Sainte Anne's. There are no citizens there. This is why we're saying those rules and regulations at Sainte Anne's should apply right across the nation.
The Acting Chair (Mr. Bob Wood): I have a point of information for you, Mrs. Wayne. I believe the minister will be appearing before us on May 25 on a full committee of SCONDVA.
Are there any other questions for our guests?
Mrs. Elsie Wayne: No. I'm on House duty, and I have to really....
The Acting Chair (Mr. Bob Wood): Thank you for taking the time to stay a little longer than you intended.
Doctor, thank you very much.
Ms. Morrison, Ms. Garrard, thank you very much for being with is this morning. I appreciate your presentation. Thank you again for all the information you brought to us.
The meeting is adjourned.