HEAL Committee Meeting

37th PARLIAMENT, 2nd SESSION

Standing Committee on Health

EVIDENCE

CONTENTS

Monday, February 24, 2003

¹

1540

The Chair (Ms. Bonnie Brown (Oakville, Lib.))

Mr. Svend Robinson (Burnaby—Douglas, NDP)

The Chair

Mr. Svend Robinson

The Chair

Ms. Elaine Johnston (Director, Health Secretariat, Assembly of First Nations)

¹

1545

The Chair

Mr. Rob Merrifield (Yellowhead, Canadian Alliance)

Ms. Elaine Johnston

Mr. Rob Merrifield

Ms. Elaine Johnston

Mr. Rob Merrifield

¹

1550

Ms. Elaine Johnston

Mr. Rob Merrifield

Ms. Elaine Johnston

Mr. Rob Merrifield

The Chair

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

Ms. Elaine Johnston

¹

1555

Mr. Réal Ménard

Ms. Elaine Johnston

Mr. Réal Ménard

Ms. Elaine Johnston

The Chair

º

1600

Ms. Carolyn Bennett (St. Paul's, Lib.)

Ms. Elaine Johnston

Ms. Carolyn Bennett

Ms. Elaine Johnston

º

1605

Ms. Carolyn Bennett

Ms. Elaine Johnston

Ms. Carolyn Bennett

Ms. Elaine Johnston

Ms. Carolyn Bennett

The Chair

Mr. Svend Robinson

Ms. Elaine Johnston

º

1610

Mr. Svend Robinson

Ms. Elaine Johnston

Mr. Svend Robinson

Ms. Elaine Johnston

º

1615

Mr. Svend Robinson

Ms. Elaine Johnston

Mr. Svend Robinson

Ms. Elaine Johnston

Ms. Marilyn Carpentier (Canadian Prenatal Nutrition Program Coordinator, Health Secretariat, Assembly of First Nations)

Mr. Svend Robinson

Ms. Marilyn Carpentier

º

1620

Mr. Svend Robinson

The Chair

Ms. Marilyn Carpentier

The Chair

Ms. Marilyn Carpentier

The Chair

Ms. Marilyn Carpentier

The Chair

Ms. Marilyn Carpentier

The Chair

Ms. Marilyn Carpentier

The Chair

Ms. Marilyn Carpentier

The Chair

Ms. Marilyn Carpentier

The Chair

Mrs. Carol Skelton (Saskatoon—Rosetown—Biggar, Canadian Alliance)

Ms. Elaine Johnston

Mrs. Carol Skelton

º

1625

Ms. Elaine Johnston

Mrs. Carol Skelton

Ms. Elaine Johnston

The Chair

Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance)

Ms. Elaine Johnston

º

1630

Mr. James Lunney

Ms. Elaine Johnston

Ms. Marilyn Carpentier

º

1635

Mr. James Lunney

Ms. Elaine Johnston

Mr. James Lunney

Ms. Elaine Johnston

The Chair

Mr. Réal Ménard

Ms. Elaine Johnston

Mr. Réal Ménard

Ms. Elaine Johnston

Mr. Réal Ménard

Ms. Elaine Johnston

Mr. Réal Ménard

º

1640

Ms. Elaine Johnston

Mr. Réal Ménard

The Chair

Ms. Carolyn Bennett

º

1645

Ms. Elaine Johnston

Ms. Carolyn Bennett

Ms. Elaine Johnston

Ms. Carolyn Bennett

The Chair

Mr. Svend Robinson

The Chair

Mr. Svend Robinson

The Chair

Mr. Svend Robinson

º

1650

Ms. Elaine Johnston

The Chair

Mr. James Lunney

º

1655

Ms. Elaine Johnston

The Chair

Ms. Elaine Johnston

»

1700

The Chair

Ms. Elaine Johnston

The Chair

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CANADA

Standing Committee on Health

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NUMBER 023

l

2nd SESSION

l

37th PARLIAMENT

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EVIDENCE

Monday, February 24, 2003

[Recorded by Electronic Apparatus]

¹  (1540)  

[English]

    The Chair (Ms. Bonnie Brown (Oakville, Lib.)): It's my pleasure to call this meeting of the Standing Committee on Health to order and to welcome our guests from the Assembly of First Nations. Thank you for the big booklet you gave us, which I'm sure will be hopeful.

    Mr. Svend Robinson (Burnaby—Douglas, NDP): On a point of order, Madam Chair, before we get started, I'm a new member of this committee and I would like to get some clarification as to the quorum that is required for hearing witnesses. I see there are no Liberal members here at this meeting other than the chair, which I find extraordinary, given that we have the Assembly of First Nations appearing. What are the rules with respect to the hearing of evidence and the absence of any government member other than the chair?

    The Chair: The reason I didn't start was that I thought we had to have at least one member from the government and one member from the opposition. The clerk just informed me that we only need to be assured of one member of the opposition. Seeing that we have a number of opposition members present, I don't want to hold up our witnesses, or you, any longer. The rules don't require me to wait, although I understand from our whip's assistant that two people are on their way from their offices. I think we could begin.

    Mr. Svend Robinson: Just for clarification, was a motion adopted with respect to quorum in this committee? What does the motion say?

    The Chair: The motion stipulates at least three members, one of whom must be from the opposition.

    Thank you, Mr. Robinson.

    Ms. Johnston, you have the floor.

    Ms. Elaine Johnston (Director, Health Secretariat, Assembly of First Nations): Thank you, Madam Chairman.

    Members of the committee, I want to thank you for allowing me to speak before you today, and I also acknowledge that this great Parliament of the people stands on the traditional lands of the Algonquin people. I also want to send regrets on behalf of Vice-Chief Wilson Bearhead. He is the co-chair, along with Vice-Chief Charles Fox, and he was supposed to be here today, but we got a phone call that he couldn't get the plane and couldn't be here on time. My remarks are based on those he was going to make to you today.

    I trust that you are all in good health. I'm afraid I cannot say the same for many of our first nations peoples. Many first nations people are unhealthy and unhappy, and we want to change that. We have to be optimistic for the sake of our young people. Children are the future of our people and the future of this country, and they are our most precious resource.

    The Speech from the Throne promised to close the gap in the health status between aboriginal and non-aboriginal Canadians. It also mentions children, which we all agree is a priority. However, much of the new funding promised for children has not reached the communities and the children, the ones who should be receiving these much needed services. Deficit reduction, bureaucracy, and red tape have captured much of these new resources. For example, $17 million for special needs children was mostly spent at the INAC regional offices. Another example is the tobacco strategy: $10 million was announced, but only $2 million reached community tobacco initiatives. We encourage the Standing Committee on Health to review and recommend changes, in partnership with the first nations, on the processes for allocating these moneys.

    The Romanow report has a whole chapter devoted to aboriginal health. It acknowledges the large gap in health status between first nations and ordinary Canadians. Romanow says many of us are victims of pervasive poverty, persistent racism, and a legacy of colonialism. Many of our children are at risk from the moment they are born--diabetes, fetal alcohol syndrome, poor nutrition, inadequate and overcrowded housing, substance abuse, violence, disability, despair, suicide.

    We are tabling the submission we were hoping to make to the First Ministers, which includes a detailed analysis of all the various reports, Romanow, Kirby, and the Royal Commission on Aboriginal Peoples. This is the report that's here for you, and we've also done it in French. Romanow mirrored some of the recommendations of the 1996 Royal Commission on Aboriginal Peoples report, but government has not taken action on any of these recommendations. Again, we urge the Standing Committee on Health to review these recommendations and work with us to support them in an effort to close the gap.

    Dialogue with first nations will go a long way towards righting the wrongs of the past. We can find solutions together to the issues plaguing first nations. Cultural exchanges are also very important, so that we share and learn from each other. It is a wonderful opportunity to build bridges that will be crossed many times together. We are optimistic that Canadians are very concerned, compassionate, and caring about their cousins, friends, and neighbours, the first peoples. We are optimistic that we can share in the health and happiness enjoyed by all Canadians.

    Since the 1993 Liberal red book this government has promised to close the gap between aboriginal and non-aboriginal people. That pledge has been repeated in Speeches from the Throne. Again last Tuesday Minister Manley stated in his budget speech, “We must also acknowledge the unacceptable gap in health status between aboriginal and non-aboriginal Canadians. We must do more and we must do better, and we will.” Unfortunately, this budget is extremely disappointing, because the $1.3 billion over five years will not meet the existing program levels at the First Nations and Inuit Health Branch, let alone support any new programs. We are tabling our analysis of the federal budget, where you will find that Health Canada's First Nations and Inuit Health Branch is anticipating an $800 million deficit over three years. Unfortunately, we do not have it in French, but we will be forwarding it to you in French as well.

    How are we supposed to close the gap in health status when deficit reduction and sustainability of existing programs is an issue? Health reform is very difficult to implement under these circumstances. How can we close the gap with minimal resources? How can we ever close the gap with funding that never reaches the people who need it the most, funding that is eaten up at the federal level by bureaucracy and red tape? How can we ever hope in our lifetimes to emerge from third world health and social conditions? How can we ever hope to provide a bright, healthy future for our children?

    Earlier this month we had a perfect opportunity to participate in the first ministers conference on health, but we were denied the opportunity. We cannot afford another missed opportunity. We do not want to miss the opportunity of participating in the new Canada Health Council. We consider health a treaty right, a lasting commitment by the federal government. We understand the Minister of Health says this is not within her mandate. Perhaps she should consult with the Minister of Justice and her federal colleagues on this issue.

    We also have very grave concerns about the non-insured health benefit consent forms. We are just as concerned about patient safety as the federal government, but these consent forms, which first nations people must sign in order to get medical attention, is not the route to take.

    If you really want to do more and do better, as the finance minister has stated, we must be able to be full partners in health care. We must be able to participate in the discussions, decisions, development, and delivery of health services.

¹  (1545)  

    I welcome any questions the committee members may have, and again I thank you for this opportunity to speak. I hope we can provide a follow-up presentation within six months time. I'll look forward to the questions and on behalf of Vice-Chief Wilson Bear Head, I thank you, meegwetch.

    The Chair: Thank you.

    We'll proceed to the questions. Mr. Merrifield.

    Mr. Rob Merrifield (Yellowhead, Canadian Alliance): I want to thank you for coming. I'm sorry there weren't more of us here, but those who are will hopefully get some insight on the plight of first nations.

    I certainly appreciate this book, because I've been looking forward to seeing your assessment of what Mr. Kirby, Mr. Romanow, and others have said with regard to first nations. As to the $1.3 billion that was in the accord, for us, looking at it, it's $1.3 billion, but details were very sketchy on whether it is going to hit the need and be appropriate.

    You're saying there's an $800 million deficit. Is that over a three-year period?

    Ms. Elaine Johnston: That's correct.

    Mr. Rob Merrifield: That's a budget deficit you have right now?

    Ms. Elaine Johnston: That's a budget deficit right now within Health Canada First Nations and Inuit Health Branch

    Mr. Rob Merrifield: Okay, just in that branch alone.

    With this $1.3 billion, you have analysed, I'm sure, when it's suppose to be applied. When you look at the numbers coming out of that accord, they're spread out over a lot of years. There's a lot of negotiation to go on with regard to some of the dollars that flow. How do you assess this $1.3 billion, and when is it going to be available?

¹  (1550)  

    Ms. Elaine Johnston: We've been trying to establish that as well. If you look at the breakdown, it's over five years. We're anticipating that it might amount to about $260 million a year. They do mention nursing, capital expenditures, and immunization. So a chunk of that money is going to be used for those three priorities, as well as taking care of the existing programs. It's very difficult to understand how that's going to be done.

    The biggest cost driver of the budget right now is the non-insured health benefits. I would say that's about 50%, and that is the biggest problem. The experience of the northern communities, the remote communities, is the same as those the territorial governments are experiencing in regard to transportation. Those costs are very high, and they do come out of the non-insured health benefits.

    Mr. Rob Merrifield: While we're on non-insured health benefits, I've had a number of dentists, as well as first nations people, talk to me with regard to the whole area of dentistry among first nations, and they're so frustrated with the bureaucracy and red tape in Ottawa with regard to first nations people coming into the dentist and having an assessment done of what is needed to repair their teeth and dental work. They can't proceed with it until approval is reached from Ottawa, and then the funding is also determined, rather than giving the opportunity to the dentist himself, the person looking in the mouth, to actually assess the problem. I've received more of it from the dentists' side than I have from first nations, and some of the dentists are saying, we're going to refuse to treat. I'm wondering if that's what you're experiencing, if you're hearing that same concern, of if there's another side to it.

    Ms. Elaine Johnston: We're hearing the same thing. They feel bureaucracy is a problem. The issue here is whether a person needs a particular dental service. It still has to get prior approval, and if it's not within their categories, they are denied service. So there are discrepancies between what the dentists feel the need is for the client and what the funder will provide. We're also finding that more and more of our people are starting to use the services as they get prevention programs saying they need to get this kind of dental service, which also increases the need in the budget line for that service.

    So it is problematic. I know Health Canada, as part of their efficiencies, is looking at cutting some of those services under non-insured health benefits, because there isn't enough money. So we're in a balancing act of trying to meet the services with the limited funds we have.

    Mr. Rob Merrifield: Thank you.

    The Chair: Thank you.

    Mr. Ménard.

[Translation]

    Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): Let me ask you a preliminary question. Could you bring us up to date on how many people the Assembly of First Nations represents and what are the main components of your organizations?

[English]

    Ms. Elaine Johnston: The Assembly of First Nations has 633 first nations communities. We represent the members that live on and off reserve. I mentioned the non-insured health benefits as an example, and they are provided to first nations members that are on and off reserve, mostly on reserve, but you do not have to live on reserve to receive that service. So you can be living in an urban setting and secure the non-insured health benefits. The Assembly of First Nations is a political organization for our first nations on and off reserve, that is our constituency. We work with the chiefs and councils across Canada.

¹  (1555)  

[Translation]

    Mr. Réal Ménard: I took a quick look at your brief, and I promise that I will read it in detail. It is very important for us to have this information. You said the people you represent were ranked 63rd in the world with regard to health factors or state of health.

    What do you mainly expect from this committee? How could we help you with specific recommendations?

    I remember that around 1997, this committee had produced a report on the health of Aboriginal people. It even travelled to the Aboriginal communities. I was not the critic at that time; it was my colleague Ms. Picard from Drummond. I feel that there has not been much improvement since the committee looked specifically at health conditions among Aboriginals.

    What do you mainly expect this committee to recommend? What should it recommend to force the government to make some kind of move?

[English]

    Ms. Elaine Johnston: If I understand the question, you're asking what support the standing committee can provide to us as first nations. There were recommendations put forward by Romanow and the Royal Commission on Aboriginal Peoples, and if those recommendations are looked at and supported, there can be some movement forward. What we were hoping to do at the first ministers conference was table this, with an idea of how we could be involved as first nations. In this presentation there are existing structures being revamped that involve both the provinces and the federal government. We were suggesting that we be part of those existing structures. There could be an aboriginal governing committee within the existing structures that would involve the aboriginal peoples in finding solutions. These structures also, as I mentioned before, do involve the provincial governments and the federal government. I guess that's what we're asking for, support to move forward on putting into action the recommendations that have come forward. Because the problem we see with the accord is that it mentions aboriginal people, but it doesn't say how they're going to do that.

[Translation]

    Mr. Réal Ménard: I understand two things.

    You said that if a Canadian council or some other body for monitoring, making observations or decisions were created, you would like to be represented within that body. At least I gather that much.

    For instance, how would you describe the availability of first-line services? Would you share your knowledge about this with the committee?

    First-line services include whatever is not included in hospitalization; it is health care that people seek in clinics, for instance. It includes all the health care that is not delivered within the hospital. You know that the Romanow report established this as a priority and recommended specific funds for this purpose.

    How could you describe the situation for Aboriginals, especially with regard to first-line services?

[English]

    Ms. Elaine Johnston: The national chief was very interested in Romanow's recommendation, which was also in the Royal Commission on Aboriginal Peoples, of looking at a framework agreement that developed the processes exactly in the way you speak about, because there are federal services that are provided as well as provincial services. There are cross-jurisdictional issues. That, I think, has been clearly outlined in the RCAP and in Romanow. We need to resolve those matters, because if we're trying to close the gap on health status, it does involve provincial discussions as well as federal. My understanding of what the national chief was talking about is, develop that framework agreement, and then you probably will have as part of that framework agreement a process laid out as to how it happens federally, nationally, as well as within the regions, right down to the community level. The opportunity was missed for the first ministers to have that dialogue, but now can we explore another opportunity to address that and move this forward?

    The Chair: Thank you, Mr. Ménard.

    Ms. Bennett.

º  (1600)  

    Ms. Carolyn Bennett (St. Paul's, Lib.): Thank you very much.

    In your diagram here you have “Health Renewal, Inuit”. That's a committee that's already been up and running, right, the joint committee on health renewal?

    Ms. Elaine Johnston: That already is a committee of the first nations and Inuit. It does not involve all the other aboriginal communities. It was mandated apparently by the minister prior to Minister McLellan. It was to revamp the health system for first nations and Inuit. It came about even prior to Romanow.

    Ms. Carolyn Bennett: Right.

    Do you think that committee should be broadened to include all aboriginal peoples? How would you organize that? Obviously, a lot of us have hopes for the health council, that it would be a partner. The federal government has its own problems in delivering health care, not only working with their responsibility to aboriginal people, but with corrections, veterans. We have some of our own troubles. So do you see a health council working to the best of its capabilities with people coming in and out of corrections, on reserve and off reserve, with the reality of a people-centred approach to the governance of health care? Have you thought about that? I know in your draft agreement you wanted to work towards the covenant and the council, but do you have an idea of what that council would look like, so that you would feel you were equal partners at the table?

    I have this small idea that it will have to be collaborative. Segmenting bits off hasn't worked up to now, so we've all got to work together on this file. Closing the gap means measuring things the same way, waiting lists the same way, everything the same way, so that we really can know what the gap is, so we can work towards bridging it. There have been many different views of what this council would look like. Some of us think, if there's one deputy minister on it, it's already a disaster. How could you help us, or would you come back to the committee on what would be an optimal governance structure? Would you see, as Romanow did, half the appointments from governments, federal, provincial? I think there were the regents, two from the feds, and seven eminent persons. Do you think there should be no government reps, all eminent persons, somebody with expertise on aboriginal issues? How would you see that council?

    Ms. Elaine Johnston: On the health renewal forum we already have, you were asking whether we should expand it. We had a problem with that, because the heath renewal table is made up of first nations and Inuit, where we've already had a dialogue. We do get specific funding federally for first nations and Inuit. The First Nations and Inuit Health Branch of Health Canada does get that funding. So this table has been doing some work so far on that whole issue of health renewal.

    The aboriginal committee on aboriginal health is a new box we've put in. As we understand the structure, whatever comes out of the first ministers conference comes down to the ministers of health and the deputy ministers, the workhorses, if you will. The chiefs committee on health met a week ago and supported this idea of having an aboriginal committee on aboriginal health. Aboriginal people from both on and off reserve would be part of this committee. You would have provincial and federal people to have a dialogue on how we close the gap.

    In regard to this health council, I think that's a different committee. We haven't really talked about how we would envision it, because we're not quite clear on what people's visions are for this health council, but there are probably two things that need to happen. We need to be part of this structure, however it's formed, of the health council, and if there is a desire or support for this aboriginal committee, we should do that. That would probably be the route to try if we want to talk about closing the gap, about efficiencies. The Minister of Finance, when we met with him, said it's not just about money. We said, yes, we understand that, but we need to be part of the solutions. This is something we're proposing as a structure on which we could attempt to do that.

º  (1605)  

    Ms. Carolyn Bennett: So you would see yourself on this diagram as part of the almost public service FPT tables of governance, and then you would want to think about what we would do with this separate council for accountability and planning. Some people think you can't do accountability and plan in the same room. If you're part of the planning, you're going to be in a conflict when it comes to the report card. I think that's what some people are still confused about, the role of the council, as to whether it does a little bit of setting the goals and objectives and then measuring them.

    Ms. Elaine Johnston: I would tend to agree with you, and I think the intention here is to have the aboriginal committee have the providers, just as the provinces and federal government do, made up of deputy ministers and policy people. So that would be the form there for that dialogue. The health council, as I understand it, is separate and has a sort of accountability piece to it that would have a different membership, as I would see it. What we would hope is that the aboriginal community has some participation in designating members to it or whatever, because I'm not sure what this committee is. Who's going to start it up? That's unclear to me as well.

    Ms. Carolyn Bennett: Say the council's 14 people. I guess in your draft agreement you said you wanted to be able to have proportional representation on the council. What would make you feel comfortable on the council in respect of the representatives from our aboriginal peoples, and how do you think they should be selected?

    Ms. Elaine Johnston: I think leaving it up to the aboriginal groups would be the way to do that. The Minister of Health was mandated by the Prime Minister to meet with the five national aboriginal organizations, which she did just after Christmas. The question was whether we were prepared to move forward on dialogue. She indicated there was that commitment. We did meet with the Deputy Minister, Ian Green, and he is meeting with the deputy ministers for the provinces to talk about how they involve the aboriginal community. I understand that is to happen very soon, but I'm not sure what form it's going to take or how quickly this is going to happen. There are the five organizations. The Assembly of First Nations is one of the five, and as the chiefs committee on health has said, there are two things they want to see, some involvement in the health council and the creation, if possible, of an aboriginal committee.

    Ms. Carolyn Bennett: Thank you.

    The Chair: Thank you, Ms. Bennett.

    Mr. Robinson.

    Mr. Svend Robinson: Thanks very much.

    I want to follow up on Ms. Bennett's question, to have a clearer sense of the nature of involvement you are suggesting in the health council. I assume you would be suggesting that there be a number of representatives of first nations peoples as full members of that council. Is that correct?

    Ms. Elaine Johnston: What we're asking for is to have members on it. We're not sure, again, what the structure of this committee is going to be. We want to be able to say we should have some kind of representation. Let's say it's decided to make it a small committee, of 15 perhaps. Then we would like to ensure that there is representation of one member at least on this committee. If it is an accountability committee, we are concerned about accountability as well, and so we would like to see some representation.

º  (1610)  

    Mr. Svend Robinson: Sure. I don't think you'll get much disagreement from folks around this table on that.

    Bear in mind that I'm new to this portfolio, so some of these questions I'm sure my colleagues will already have answers to. What about the often desperate health conditions of urban first nations people? Who actually has responsibility for them now? Does Health Canada accept any responsibility, is it strictly under the general health responsibilities of the provinces? I'm thinking, for example, of the conditions of first nations people in the downtown east side of Vancouver, which is very close to the constituency I represent, which are absolutely appalling. Who has responsibility for responding to this situation?

    Ms. Elaine Johnston: The chiefs say they have responsibility for all of their members, regardless of where they live. However, I'm going to put a qualifier on that. Health Canada provides funding only for those people living on reserve, except with the non-insured health benefits. The first nations communities get funds from the federal government for services that are provided on reserve. The federal government also provides the non-insured health benefits, which I said represent 50% of the budget, regardless of where you live, so you could be living in Vancouver. The other services in most cases, I would say, are provided by the provinces.

    Mr. Svend Robinson: Romanow proposed a different model of governance. You've certainly proposed that there be far more direct involvement of first nations people in decision-making on health issues. Could you tell me a little about the extent to which the present reality directly involves representatives of first nations in decision-making? We have this bureaucracy in Health Canada. To what extent are first nations people actually involved in making decisions in Health Canada on aboriginal health issues, and to what extent are they directly involved in at least consulting with people on the ground about these decisions?

    Ms. Elaine Johnston: I would say, for the most part, they're not very involved on the federal government side. That's been the challenge, trying to include first nations in decision-making. In some cases the provinces have involved the first nations in decision-making. There are some models out there. In Ontario there is the aboriginal healing and wellness strategy. The Province of Ontario has been working with the aboriginal community, and the various departments and the various aboriginal groups meet about every six weeks. They talk about funding, policies, and programs. That is one model. It certainly has its problems, but it has been working in Ontario. There are probably other models out there.

º  (1615)  

    Mr. Svend Robinson: I was thinking of the feds particularly.

    Ms. Elaine Johnston: With the federal government, there haven't really been any structures in place for that kind of involvement. That's why we're proposing this. We keep saying we want to have involvement, and everybody asks how they should involve us. The question always is the whole issue of consultation. Just because we've been to a meeting, does it mean you've consulted with us? That's the problem. We're looking for a structure that talks about real involvement.

    Mr. Svend Robinson: I think one of the biggest scandals with aboriginal health is the appalling problem of access to clean water in many parts of Canada. I've seen too many horror stories about poisoned and contaminated water and people dying. Long before Walkerton, frankly, many first nations people were dying, and nobody was paying any attention. I wonder if you could talk a bit about the extent to which that is still a serious problem and the extent to which the most recent budget or the health accord responded to it.

    Also, perhaps Ms. Carpentier could speak about the issue of prenatal care and fetal alcohol syndrome and the extent, again, to which there are adequate resources to respond to some of the very serious concerns in that area.

    Ms. Elaine Johnston: Health Canada has confirmed that about 9% of on-reserve water systems are probably serious health risks. With the recent budget announcement, we're wondering whether that is really going to address all the water systems. I think it's just going to be a step. You have first nations, especially in the remote areas, that do not even have potable drinking water. I speak from being a nurse and having worked in communities where you have people who are still hauling water and drinking it out of a bucket. So there's a matter of infrastructure, and when you do have systems, are the people appropriately trained to take care of the infrastructure that exists? There are a number of issues that need to be addressed.

    When I was in my previous job at North Shore Tribal Council, the question was posed to me at the time of Walkerton, are you surprised? I said, well, we've been experiencing this as first nations longer than Walkerton, so I'm not surprised. I'm surprised, though, that in a country where we say we have all the amenities this would happen in a community that is not first nations, not in the north, not in a remote area. That was a surprise, but we've been dealing with this as first nations for quite some time.

    I think the budget announcement is not going to be able to address all the needs. If anything, it could touch the tip of the iceberg, if you will, but there's still a lot of work that needs to be done.

    I'll let Marilyn answer your other question.

    Ms. Marilyn Carpentier (Canadian Prenatal Nutrition Program Coordinator, Health Secretariat, Assembly of First Nations): I'll start with FAS. It's a very big concern among our people, but it's not just an Indian problem, it's all over. There hasn't been an assessment done, so we don't know the actual figures, but we know it's very high in aboriginal communities. The $10 million that was targeted for this year is not going to reach the communities. This money hasn't been released yet to the regions. There's not enough time in the year for the first nations to even do the work that has to be done.

    Mr. Svend Robinson: Sorry. The money hasn't been released yet?

    Ms. Marilyn Carpentier: That's correct, it hasn't been released. We don't expect to even see it at the community level. This is happening with our funding time and time again. They make these big announcements. In fact, I think this has been announced five times now, and it hasn't reached the communities. This year it's very late in the fiscal year. We're already towards the end of February. I'm starting to wonder about these announcements. Are they ever going to get the money? Is it ever going to get to the communities where they need it the most? It's the same thing with head start. It's going into these deficits Elaine was talking about with the non-insured. So as for prevention programs for the children, I don't think it's even going to go the communities this year, it's going to go towards these deficits. We're never going to get ahead. It's scary.

º  (1620)  

    Mr. Svend Robinson: Thanks very much. I wonder if we could ask our researchers to check into this and find out exactly what's happening.

    The Chair: That's a good idea, Mr. Robinson, with both the FAS dollars and the head start dollars. Were the head start dollars announced in October as well?

    Ms. Marilyn Carpentier: Yes.

    The Chair: Okay. I suppose there are some forms and statistics that have to be gathered before you apply?

    Ms. Marilyn Carpentier: As far as I know, there was a meeting in May. The advisory committee for head start were told to begin their work plan, to get ready for this new money, which never materialized. Of course, that's where some of the problems are. The people in first nations communities and regions are prepared for this money, but now we find out it's not going to them.

    The Chair: So they are ready to submit their plan for the money, as directed?

    Ms. Marilyn Carpentier: They were told to be ready in May, and they started preparing.

    The Chair: The money was announced in October. Did they send their requests in?

    Ms. Marilyn Carpentier: Yes, at the regional level. I think some of the money went out for head start, but a good chunk of it is held back or is going towards the deficit. It's the same thing with FAS. We did ask, but because it was so late in the year, they told us, at least $2.5 million is going to be rolled over to next year.

    The Chair: Rolling over isn't as bad as its going to someone else's deficit.

    Ms. Marilyn Carpentier: But from what we're hearing, most of it is going towards the deficit, and FAS dollars too, where they only gave the regions the same as in the previous years, which is a total of about $1.5 million. So the $10 million we were promised is not going to the communities.

    The Chair: So $10 million was announced in October for FAS?

    Ms. Marilyn Carpentier: Yes, for this fiscal year.

    The Chair: How much was announced for head start?

    Ms. Marilyn Carpentier: That was $25 million.

    The Chair: For this fiscal year that we're coming to the end of. Okay. Well, that's very interesting. Thank you.

    Ms. Skelton.

    Mrs. Carol Skelton (Saskatoon—Rosetown—Biggar, Canadian Alliance): I'd like to go back, continuing on this line. Elaine you mentioned there was $10 million budgeted for the smoking, and only $2 million reached the people. Where did the rest of it go, or did you get it?

    Ms. Elaine Johnston: We haven't got it, so we're not sure where it's gone. That's the issue we're raising when we say bureaucracy and red tape. We find it very interesting when we hear that there are billions of dollars spent on us as first nations people. We'd like to see a tracking of when it's announced and when it finally reaches the communities, because we're not seeing it, and that's our concern: where does it go if it's not reaching the communities?

    Mrs. Carol Skelton: So you have $2 million, but the other $8 million that was promised has never come to you.

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    Ms. Elaine Johnston: That's right.

    Mrs. Carol Skelton: I'm very interested in the head start program, as a member of Parliament who has a large urban aboriginal population. I know of some very good programs in our community being run by first nations people, and it really disturbs me to hear you say you are not getting the funding we are being told you're supposed to get. That's not the way it's supposed to work. I know your elders believe in the holistic approach. Can you give my your vision of ideal health care for an urban aboriginal person?

    Ms. Elaine Johnston: I think one of the things that was missed in the Romanow report--and when we did our presentation to Romanow, we talked about this--is wellness models. Traditionally, the way we provided health services was very much based on a wellness model, because it was survival of the fitest. Some of the chiefs have been raising the need to get back to the wellness model and a holistic model. Both on and off reserve, we need a wellness model that incorporates the medicine wheel concept, which looks at physical, mental, spiritual, and emotional aspects. It also looks at the four groups, when you're a child, when you're a young adult, when you're an adult, when you're a senior. So targeting programs in those areas that look at those aspects is going to be important.

    I hear some of these reports that say, if I take you off the reserve and put you in an urban setting, you'll be fine. Well, no. You're going to be ghettoized in the urban setting. So we need to look at all of those aspects to be able to get back to the wellness perspective. I think that's important, and I think that's what the elders are talking about.

    The Chair: Thank you, Ms. Skelton.

    Mr. Lunney.

    Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance): Thank you.

    First let me welcome Elaine back. I believe you were here just recently presenting to committee.

    I wanted to ask you to clarify some of the comments you made earlier. It went past rather quickly for me. I didn't quite catch the significance of it. You said much of the money was intended to help the children and those in need, and it just wasn't getting there. You mentioned the deficit reduction of some $17 million that didn't get through and something to do with tobacco. Could you please clarify that? Could you also clarify the concern about the consent forms that were being asked for to gain access to the uninsured services?

    Ms. Elaine Johnston: When I talk about the $17 million for special needs, special needs children are those who have attention deficit disorders or things like that. We're finding this with Health Canada as well as Indian Affairs. When I say this, I'm not trying to point my finger at any one person or anything like that. I think it might be a problem in the way things happen within government. That's my point. When these announcements are made, there is a high expectation that these moneys will then reach those they have been targeted for. The problem is the way bureaucracy works in having those moneys come down. I think what Marilyn was raising earlier was that there is an announcement made, but there's a quick turnaround time, and there's an expectation that you're going to have your plans ready and you're going to have spent this money. Here we are in February. Some of the regions have their announcements now for moneys, and we only have one month to spend it. That's not good planning, that's not a good way of doing business. When you talk about health reform, we need to look at structures differently. We need to say, okay, this isn't working, is there a better way of doing it?

    In regard to the issue of the non-insured health benefits client consent form, Health Canada had to do a presentation to the public accounts committee about a year and a half or two years ago. There were two cases that came forward, one from Saskatchewan and one from the Atlantic provinces. A client in Saskatchewan had taken 300 prescriptions and had overdosed and died. Health Canada's response to that was, well, we'll have to get client consent forms. But there is another problem. There is federal legislation as well as provincial legislation in Alberta specifically. Health Canada's response to this whole issue is, we need to develop a consent form, and we're going to do it. They've now decided that September is the deadline for these consent forms being signed. If the client does not sign these consent forms, they will not get service. They are being told that even today, and they're not supposed to be told that until September. Some of the first nations members are being told, if you don't sign this consent form, you're not going to get service. It is problematic, because there is also the issue of informed consent: do I understand, if I'm consenting to something, what I'm consenting to?

    Health Canada needs this consent form for two reasons. One is that First Canadian Health is the one that pays for the service. If a dentist, for example, sees a client, in order for the dentist to get paid for that service, they need the consent of the client to share that information with First Canadian Health. So the dentist has to say, I need the client's consent so I can give this information to First Canadian Health and get paid. Second, what Health Canada wants to do is use the information to find out if a person is doctor-shopping or something like that. The issue is prescriptions.

    We're saying, as first nations, is there an alternative to some of this? Is there an alternative to prescription drug overdose? When I look at non-insured health benefits and the high-cost drivers of it, if the high-cost drivers are drugs, the question in my mind, because I'm a nurse, is, what are they using the drugs for? Is it because there is high arthritis? Should we be revamping the programs to target pain medication? Maybe there need to be alternatives to pain medication. But we're not doing that piece of it.

    Our concern about the whole issue of client consent is whether, when a person is signing these, they really know what they are signing and for what, because they are being coerced to sign it.

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    Mr. James Lunney: It sounds like standard procedure in the medical world, though, as clients in all sectors have to deal with consent forms when services are provided. It is part of that accountability we're looking for. Thank you for clarifying that.

    I just wanted to ask, again, about the aboriginal head start program, because I was just invited to come up and view a program at the extremity of my riding. There are some programs that are up and running there. Are you seeing benefits from the program as it exists right now or just frustrations?

    Ms. Elaine Johnston: I'll make my comments, and then I'll let Marilyn respond as well.

    I know there are benefits to the aboriginal head start program. I know the off-reserve people have been working on the evaluation, because they've been running longer than the first nations have. There are definite benefits to this, and we certainly see that. There's also the whole point about parental involvement, and there's the cultural component, which is very beneficial. So our view is that we need to support the head start programs. The problem we have as first nations is the way it got off the ground. It can come back on track, I believe that.

    Ms. Marilyn Carpentier: I want to agree with Elaine's comments. It's very beneficial. The first nations, the aboriginal people really like the program. There is also a link with special needs and FAS. And there we go again--we need to have money. They tie it on to existing programs; the FAS dollars are working like the CPNP and head start. So we're wondering what's going to happen with that. We need those moneys. In head start they need money for capital and for transportation. Those are not big dollars, but we still need FAS dollars to enhance that program, to work with the children with special needs. The people are working educators.

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    Mr. James Lunney: Briefly describe the aboriginal head start program. What years are we talking about there, what ages?

    Ms. Elaine Johnston: Head start is pre-conception to age six. The difference between head start and day care--because people get confused with day care--is that it's pre-conception. So before the baby is born, you're working with mothers. It also involves working with the families, which day care does and doesn't do.

    Mr. James Lunney: My final question is to do with research. We want to have some research into fetal alcohol syndrome and so on. I understand there is an initiative here, the Institute of Aboriginal People's Health working with CIHR. Does the AFN have a role to play in this research initiative?

    Ms. Elaine Johnston: Yes, we're very supportive of this research initiative. Dr. Jeff Reading, who is the lead in the institute, has been working with the aboriginal community to identify what research needs to happen, and we have identified research in the whole area of children, FAS, FAE. That is one of our target areas. I know Jeff Reading has been supportive of that, and we do have a role.

    The Chair: Thank you, Mr. Lunney.

    Mr. Ménard.

[Translation]

    Mr. Réal Ménard: I want to get this right. You said that we Parliamentarians voted for funds for certain programs in the 2002-2003 budget. You mentioned three projects: the Aboriginal Head Start Program, the Fetal Alcohol Syndrome/Fetal Alcoholic Effect Initiative which we already discussed here with Judy, who preceded Svend in the NDP, and the Canada Prenatal Nutrition Program.

    Could you give us a very specific list of programs to which funds were allotted by Parliament and which still have not received those funds at the end of this financial year?

    Then, I would like the Chair to see whether the committee consents, notwithstanding the notice provided for in the rules, to immediately adopt the motion to bring before us the Minister of Indian Affairs and Northern Development. But please answer my first question first, and then we will see whether the committee agrees.

    I would like to know exactly what the programs are and approximately how much money is involved.

[English]

    Ms. Elaine Johnston: I can't give you the actual totals for each of the programs. I think our concern is with the children's Speech from the Throne moneys, which are FAS/FAE, head start, early childhood development. Those are the concerns we have. There has been some money released and there are some programs in the works. The problem is that those moneys--

[Translation]

    Mr. Réal Ménard: Approximately how much are we talking about? Give us a ball park figure of how much money you are still owed.

[English]

    Ms. Elaine Johnston: The ball park figure for CPNP is about $14 million, head start $25 million, and FAS/FAE $10 million.

[Translation]

    Mr. Réal Ménard: So you still have not got that money although it had been voted by Parliament.

[English]

    Ms. Elaine Johnston: We've got--

[Translation]

    Mr. Réal Ménard: Svend made an important observation. Let me ask you whether, to your knowledge, when the credits were voted, the Department of Indian Affairs and Northern Development had reserved $20 million or $14 million in credits in its books, for instance. Have your researchers verified this? Sometimes this can be stated in the throne speech, but it does not mean that it translates into a measure.

    This will make a big difference when we make representations to the government. If it has been announced but there has been no follow-up, then it is a broken promise. If it was announced and credits were allotted and you did not receive the money, it is a case of government incompetence, and the committee's role is to look into it.

    We must know exactly what we are dealing with.

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[English]

    Ms. Elaine Johnston: There are two issues. One is that there have been moneys received, but with the process you talked about, there's been an announcement and it's slower getting down to the first nations. The second issue is that it's related to the fiscal year. I know the regions have been just informed--we were told this at our chiefs committee on health meeting last week--of their dollar allocations for head start and FAS/FAE, and they're scrambling right now to put their plans in to spend their money for this fiscal year.

[Translation]

    Mr. Réal Ménard: I conclude by saying that I hope you will stay in touch with our researchers so that we can clarify this matter. I do not know whether we will be able to agree right away to bring the Minister of the Department of Indian Affairs and Northern Development before this committee, because we certainly must clarify this matter. We are not dealing with trifling sums. Usually, this takes a notice. I do not want to cause any problems for you, Madam Chair, but if we could reach a consensus, the matter could be solved. I will leave this up to your discretion.

[English]

    The Chair: One idea, Mr. Ménard, I might present to you at the end as to how we might handle this. I'm much more interested in making sure the moneys announced and promised, if they're not able to get plans together and get them spent within the fiscal year, which is pretty impossible with only a month left, are rolled over immediately and absolutely no way does one cent of that money get into the deficit of another part of the department. There is no such thing as a surplus in one line going to a deficit in another section of the health department at this point, but some people might be thinking that would be a good thing to do if the money isn't spent. So what we want to do is get our oar in the water and let them know it will over our dead bodies, so to speak.

    Ms. Bennett, then Mr. Robinson.

    Ms. Carolyn Bennett: I think the issue with the money is really telling, because it explains what we hear, certainly when we're up north. When there are these little pockets of money all over the place, that speaks to a lack of coherence in what we're doing. I would hope, once we sort out this money, we then develop a program. My understanding is that with the new markers for fetal alcohol effect and syndrome, we can sort out kids at 18 months. That should be part of every aboriginal head start program, even though it's an educational program, with a public health nurse able to do that present. We may prevent a mom having four more children with the effect. Usually, there's a eureka moment where the mother realizes she herself had fetal alcohol syndrome and effects, so it's not really her fault. We can begin at that teachable moment.

    So we should try to bring these programs together. Prenatal nutrition is supposed to deal with booze and drugs and smoking and all that; even though it's called a nutrition program, we know what it's really meant to do. We have this whole group of programs. Technically, they're all working well, doing exactly the same right thing, which is the best start for kids. There's the early childhood development money, a little crime prevention over here, a little bit of this, but we need wellness money, so you don't spend all your time filling out stupid forms for different little pots of money that are all meant to do the same thing. In Nunavut it's a little bit easier, because it really looks ridiculous up there that all these people are applying to programs.

    We have to get you all the money you're supposed to get, but how would you design this funding so there weren't all of these pockets of money and different governance for the money? It should be not just teachers doing aboriginal head start, but there should be a health component and an educational component to the health dollars. Help me with this.

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    Ms. Elaine Johnston: Certainly.

    The intention in our idea of having an aboriginal committee is exactly that. When you're talking about health reform, the question is, can we sustain what we have now so that we are surviving? Then let's revamp the system. We agree that the silos are preventing us from doing what we need to do. We need to get back to the wellness programs. We need to change the dynamic of what's happening. The investments you make in health promotion in wellness are going to be investments for the future, because that will change in the future, taking it away from illness, where the high costs are, into wellness. But you need to make those investments now. If you don't make those investments now, you're going to be continually dealing with illness and the high costs. That is the challenge we have before us. If we can have that dialogue, as the aboriginal community, with our colleagues in the various sectors, we can probably work on something to do that.

    That's what I would tend to see. Sustain us for now, until we can revamp the program. You mentioned the health renewal committee, and that's what we've been dealing with, that challenge. What has been upsetting the health renewal committee is that the sustainability keeps coming front and centre and keeps pushing our agenda forward. So we keep having to say we have to get back on track, because the whole point about health renewal was to ask how we could do business better and differently.

    Ms. Carolyn Bennett: Is there anything in the aboriginal head start terms of reference that insists upon the capacity to do a public health audit or have a nurse associated with the program or somebody identifying children at risk with nutrition, dentistry, anything?

    Ms. Elaine Johnston: No, there is nothing in the terms of reference. I think that's part of the revamping of the program that needs to happen in general . We must look at who needs to be involved and how you do it differently. Also, we don't have a lot of nurses, and it's going to become more of a crisis in five years. If we don't have enough nurses, who do we need to have?

    Ms. Carolyn Bennett: And what people could be trained to do this who don't happen to have letters after their name?

    The Chair: Thank you, Ms. Bennett.

    We'll go to Mr. Robinson, then Mr. Lunney.

    Mr. Svend Robinson: Thanks very much.

    On the funding, I wonder whether we could ask the chair of the committee if she could write an urgent letter to the minister, I'm sure on behalf of all members of the committee. It's important to have ministers appear before us, but this is a--

    The Chair: That's what I was going to suggest. We could waste a lot of time waiting to get a date with the minister, only to ask her a set of questions. I'm thinking of asking the researchers to develop a very precise set of questions, with an urgency to it, and talking about how concerned we are. When we get the answers back, I can write to them and say, don't you dare do anything but roll that money over, because people's plans are either there on your desk or they're very shortly to arrive.

    Mr. Svend Robinson: Perhaps we could get a consensus around the table for the chair to write that letter, not just to ask questions, but because of the urgency, to say, look, these are our questions, and if the answer is that people are expected to spend this amount of money before the end of the fiscal year, we want your assurance that there will be a rollover of the full amount into the next fiscal year.

    The Chair: Yes, exactly. We'll state our position at the bottom.

    Mr. Svend Robinson: I think it's important to do that.

    I wanted to follow up on three very specific points.

    First, I come back to my question about clean drinking water, because I do think this is a critically important issue. You mentioned that something like 9% of first nations communities don't have clean drinking water. Have there been any studies done by the AFN on this subject? Do you have any documentation you could get to the committee? Certainly, this is something I would think we want to follow up on. So if you do have some information you could provide to us with respect to not only clean drinking water, but sewage treatment facilities as well, that would be very helpful.

    Second, we talked about fetal alcohol syndrome, but what level of funding is available to deal with substance abuse concerns, particularly alcohol?

    Finally, one of the great scandals is the level of tuberculosis. I was speaking with Ed Picco, the health minister of Nunavut, who told me the level of tuberculosis in Nunavut is 17 times higher than in the rest of Canada. That's just outrageous. I suspect the figures are similar in other first nations communities. What's being done to respond to that scandal?

º  (1650)  

    Ms. Elaine Johnston: In relation to drinking water, there is a study released by Health Canada and Indian Affairs. There are a little over 100 communities that have boiled water advisories. I would have to find out for you what studies we can provide, and we can certainly send them on to you. Part of the problem with us at the Assembly of First Nations is that we get funded for contaminates, not so much for water, and so we have to try to address water within some of our other areas. I'll see what I can find for you.

    In regard to the level of funding for solvent abuse, I don't have a figure off the top of my head. There was, probably about five years ago, work done on the whole issue of solvent abuse. What came out of that was that there were solvent abuse treatment centres funded throughout Canada, and there is a foundation that is working with these treatment centres to look at the whole issue of solvent abuse. Our concern has been that they've been working on an evaluation, but we haven't really seen the outcome of those evaluations regarding what needs to be done next. The treatment centres were the outcome of the initiatives that needed to happen in solvent abuse, but as you know, solvent abuse is still a problem in the first nations communities and in Inuit communities. I'd have to get back to you on the level of funding.

    The same applies in regard to TB. The level of funding is not high. A lot of the work that is done is in the areas across Canada that do have high incidence of TB. It is not everywhere. There used to be a prevention program, immunization for all kids; they don't do that any more. That is a problem, but any funding that is spent on TB is targeted for those areas where it is most prevalentt. Also, there has been some resistance to TB medication, so they've had to really target any of their programs to those areas.

    The Chair: Thank you.

    Mr. Lunney.

    Mr. James Lunney: Thank you, Madam Chair.

    I come back to the wellness issues, particularly relating to children. We talked a little about prenatal nutrition, early childhood nutrition, and the traditional wellness model. There are big concerns about the well-being of our children, even beyond the aboriginal community. We're talking about special needs children; the incidence of learning disabled children is huge, of course, with aboriginals, but it's also through society. There are hyperactive kids; there are many communities where a high percentage of the boys in particular are on Ritalin. There's the high incidence of autism and concerns about thimerosal or mercury used in vaccines. We're doing research with the aboriginal children. We want to watch very carefully and pay serious attention to the traditional wellness model that is your background, so we make sure the interventions made to help children actually help them and don't complicate their lives. I hope that'll be watched very carefully. I wonder how you feel about that.

º  (1655)  

    Ms. Elaine Johnston: I think that it is very important. The elders say we really need to focus on the children, because they're the future of anything we're going to be doing. That's why we were very hopeful with the Speech from the Throne, because children seemed to be at the top of the agenda. Yet again, we're working in these silos. How do we change that? I think that's the challenge.

    I do know there is a healthy living strategy coming forward, and the Assembly of First Nations is going to be participating as part of the dialogue about what a healthy living strategy is. Something we want to put forward is a wellness model. We need to target the children, we need to look at all the age groups. I mentioned earlier that our children are our biggest resource, and whether aboriginal or not, that's the future of our country, so we need to really focus on that age group.

    The Chair: Thank you, Mr. Lunney.

    Mr. Robinson said earlier nobody was paying attention to water issues. I attended a conference of first nations people last summer. I don't know whether the theme of water has got me confused, but I think it was at the Wahta Reserve in Muskoka. It was very interesting. A report was written, and there was a video of the conference. We assembled a number of experts to talk about it and representatives of reserves where they were having problems. So I think people are looking at it, but it seems to me we have to move it forward on the agenda. I'll see if I can get copies of that report to circulate around the table.

    You have raised in my mind the prevention models and health promotion. For example, if a nurse, or even a teacher, is talking to moms and kids about good nutrition and the connection with dental care, the impact of losing your teeth early on your digestive system later in life, that wakes up in people's mind the idea that maybe they should go to the dentist when the dentist comes to the reserve, even if they've been avoiding it because they had a painful experience when they were children or something like that. In any case, the more we do educating people and exposing them to the benefits of health services, the higher the demand goes. I'm wondering if you're collecting any stats about the use of programs, such as an AA program on a reserve--what percentage of the known alcoholics are attending? What percentage of the people on reserve are actually seeing the dentist once a year? If those percentages are fairly small, it suggests the educational programs that might take place through head start are going to create a demand no one is planning for. If we really want to improve the general health on reserves, it seems to me we should be starting to prepare our minds for the number of dollars that will truly be needed to service the whole population, instead of maybe small portions who are, say, brave enough to go to the dentist when he or she comes.

    Ms. Elaine Johnston: You ask a very interesting question, and unfortunately, I don't have any studies. We're commissioning a study being done right now on the whole financial piece and asking how many aboriginal people actually use the services. Very preliminary information is saying hospital utilization by the aboriginal community is higher than that of Canadians in general. It is higher in some of the services, but the question we have to ask ourselves is why that is. You also have to look at poverty, education level, and all those elements.

»  (1700)  

    The Chair: It might not be that much higher if we had stats on pockets of severe poverty in cities. It's probably about the same.

    Ms. Elaine Johnston: I don't have that information, but you raise a very interesting question as to whether, if we do health promotion and prevention, we are going to increase the use of services. I would say, probably not. Studies have shown that as you do health promotion and prevention, you give choices to the individual. Schools, for example, can teach kids about looking at labels. My niece wanted to go shopping with me because she had to look at the first three ingredients, and if the first three ingredients in anything were sugar, she couldn't have it. She said she learned that at school. So they're teaching them in schools about reading labels and the ingredients you have to be careful about. Those kinds of things are important, because if you are teaching things like that, you are looking at preventing heart disease, diabetes, and those kinds of things. I think we need to look at what we are trying to decrease the utilization rates for.

    The Chair: We'd want to decrease, say, the use of a hospital, because that's for someone who is already pretty sick. On the other hand, we might want to increase attendance at the dentist to maintain a set of teeth for life. So I guess there would different criteria for each level of service you are considering. But if we want to increase the general wellness, it seems to me we have to increase these educational programs and the intervention, picking out children who are going to have problems when they're very young, which goes back to the synthesis of these various disciplines within a program such as head start.

    You've given us some very helpful things to think about, and we hope we can be helpful to you on this immediate issue about moneys that were announced. We want to make sure they get where they were supposed to go and not into some other budget line. Thank you very much, on behalf of the committee, for coming. We really enjoyed your presentation and the interaction we've had with you.

    This meeting is adjourned.